
Class. 
Book. 



COPYRIGHT DEPOSIT 



ANSWERS 



TO 



QUESTIONS PRESCRIBED 



BY 



MEDICAL STATE BOARDS. 



BY 

ROBERT B. LUDY, M.D. 



late acting-assistant surgeon, u. s. a.; lecturer on practice of medicine in temple 

college of Philadelphia; author of "answers to questions prescribed 

by dental state boards," etc. 



SECOND EDITION, REWRITTEN AND ENLARGED. 



PHILADELPHIA : 

JOHN JOS. McVEY. 
1905 






A. 



{ (wo Copies rfecetveu 

Oooyrigni entry 
/ C* KXc. Not 

"771$ 

copy b. 



Entered according to the Act of Congress, in the year 1905, 

By JOHN JOS. McVEY, 

In the Office of the Librarian at Washington, D. C. 



PEEFACE. 



The indorsement of the first edition of this book by teach- 
ers and students, as shown by numerous expressions of ap- 
proval, as well as by its rapid sale, is extremely gratifying 
to the author and seems to warrant its continuance. 

All new State Board questions which have appeared since 
the publication of the first edition have been added. It is 
hoped that the careful revision to which the work has been 
subjected has eliminated the errors which appeared in the 
first edition. 

Everything has been sacrificed to brevity and accuracy, so 
that students will find the book indispensable in preparing for 
college, hospital, army and navy examinations in the shortest 
possible time. 

Many persons having an adequate knowledge of the subject 
in which they are tested, fail because of their inability to 
interpret properly the intents and purposes of the questions 
to be answered by them. To aid in this, as well as to afford 
a convenient manual for the general preparation of medical 
students in their work, is the sole object of this book. 

Having collected a large number of questions from differ- 
ent states, it was found that duplications occurred ranging 
from 30% to 80%, varying according to the several subjects. 
Thus a comprehensive knowledge of these questions and an- 
swers will serve excellently in the preparation of future ex- 
aminations before such Boards. 

In order to secure a critical interpretation of the questions, 
and concise, yet complete, answers to the same, the author 
has been favored by the assistance of well-known specialists 
in their several lines, whose competence and experience give 

(iii) 



iv PREFACE. 

to the work a range and value impossible of attainment in the 
product of a single author. 

It has been deemed advisable to unite all questions from 
the different States under their respective headings, so that 
undue repetitions of similar questions might be avoided. 

Although standard literature has necessarily been consulted, 
yet in a work of this character references would only prove 
cumbersome; hence they have been generally omitted. 

To Drs. Babcock, Boom, Coley, Dorland, Good, Northrop 
and Thomas the author makes grateful acknowledgment. The 
high value of their carefully-prepared answers is fully appre- 
ciated by him, and will be by those into whose hands the work 
is committed. Eobert B. Ludy. 



SPECIAL AUTHORS. 



Herbert L. Northrop, M. D. 

Professor of Anatomy, and Associate Professor of Surgery in Hahne- 
mann Medical College of Philadelphia. 

Wm. Harmar Good, A. M., M. D. 

Demonstrator in Physiology at the Medico-Chirurgical College of 
Philadelphia. 

Henry H, Boom, M. 1), 

Professor of Chemistry, Physics and Metallurgy in the Philadelphia 
Dental College. 

W. Wayne Babcock, M. Z>. 

Professor of Surgery and Clinical Surgery in Temple College of 
Philadelphia ; Assistant Pathologist to the Philadelphia Hospital, and 
Joint Author of Vol. V. , Cohen' s System of Physiologic Therapeutics. 

W, Hersey Thomas, M. D. 

Lecturer on Surgery , Medico-Chirurgical College ; Assistant Surgeon , 
Medico-Chirurgical Hospital. 

W. A. Newman Dorland, M. D. 

Associate in Gynecology, Philadelphia Polyclinic ; Assistant Obstet- 
rician, Hospital of the University of Pennsylvania ; Author of " Mod- 
ern Obstetrics," System of American Medical Dictionaries, etc. 

Thomas L. Coley, 31. D. 

Assistant Visiting Physician and Chief of Medical Dispensary, 
Methodist Episcopal Hospital ; Associate Editor Therapeutic Monthly. 

(v) 



CONTENTS. 



PAGE 

I. Anatomy 1 

By Herbert L. Northrop, M. D. 

II. Physiology 65 

By Wm. Harmar Good, A. M., M. D. 

III. Hygiene 127 

By Robert B. Ludy, M. D. 

IV. Chemistry ,. 163 

By Henry H. Boom, M. D. 

V. Pathology and Bacteriology 303 

By W. Wayne Babcock, M. D. 

VI. Surgery 335 

By W. Hersey Thomas, M. D. 

VII. Obstetrics and Gynecology 429 

By W. A. Newman Dorland, M. D. 

VIII. Therapeutics and Materia Medica 515 

By Thomas L. Coley, M. D. 

IX. Practice of Medicine 609 

By Robert B. Ludy, M. D. 
( vii ) 



ANATOMY. 



Mention the sutures at the vertex of the skull and state 
what bones they unite. 

Sagittal suture, uniting the two parietal bones; lambdoid, 
uniting occipital with both parietals; coronal, uniting both 
parietals behind with frontal anteriorly. 

Mention and describe the salivary glands. 

Parotid, submaxillary, sublingual. Parotid, largest, placed 
in front of ear, behind ramus of mandible; duct (Steno's) 
passes across masseter muscle, perforates buccinator muscle, 
terminates in cheek wall opposite upper middle molar. Par- 
otid has facial nerve, external carotid artery, temporo-maxil- 
lary vein passing through it. 

Submaxillary gland is located upon inner side of body of 
mandible posteriorly, is crossed by facial artery; duct (Whar- 
ton's) passes forward, terminating close to frsenum linguas. 

Sublingual gland, located in shallow fossa upon inner side 
of body of mandible, near symphysis, is covered by mucous 
membrane of mouth; ducts (Bartholin's) terminate near 
frgenum linguae. 

Mention any one muscle which moves the humerus (a) 
forward, (b) backward, (c) inward. 

(a) Coraco-brachialis ; (b) posterior fibres of deltoid; (c) 
latissimus dorsi. 

What would be the collateral circulation if the brachial 
artery were ligated below its profunda branches? 

Superior and inferior profunda above, anastomotica magna, 
radial and ulnar (anterior and posterior) recurrent below. 

(i) 



2 ANATOMY. 

Describe the Meibomian glands. 

Sebaceous glands embedded in posterior surface of tarsal 
plates of eyelids, consisting of single duct with closely at- 
tached acini, orifices of ducts terminating in single row of 
apertures along posterior lid-margin. 

Give location and a description of the tubercula quad= 
rigemina. 

Located upon upper surface of crura cerebri, just behind 
third ventricle and beneath posterior part of velum inter- 
positum; nates anterior to testes. They Consist of gray mat- 
ter externally, white internally, and are connected with bra- 
chia of optic tracts. 

Describe the renal blood circulation. 

Arterial blood enters sinus through hilum by means of renal 
artery, branches of which pass between Malpighian pyramids 
to cortico-medullary junction, where they form transverse 
branches which send arterioles into cortical and medullary 
portions of kidney, forming glomeruli in the former, and 
plexuses around the uriniferous tubules in the latter. The 
veins collect the blood from these parts, form cortico-medul- 
lary branches and pass through medullary portion between 
pyramids, leaving kidney through sinus as renal vein. 

Mention the muscles attached to the great trochanter 
of the femur. 

Gluteus medius and minimus, pyriformis, obturator inter- 
nets, gemellus superior and inferior, obturator externus. 

What arteries, muscles and nerves would be severed in 
a cross=section at the middle of the humerus? 

Brachial, superior and inferior profunda; biceps, triceps, 
insertions of deltoid and coraco-brachialis, origin of brachi- 
alis anticus; musculocutaneous, internal cutaneous, median, 
ulnar, musculo-spiral. 



ANATOMY. 3 

State origin, course, and distribution of sixth cranial 
nerve. 

Superficial origin, from groove between medulla and pons; 
course, forward through cavernous sinus, exit from cranial 
cavity by sphenoidal fissure; distribution to external rectus 
of eye. 

Give the relations of the right kidney. 

Rests upon quadratus lumborum and psoas magnus muscles, 
is in contact with under surface of right lobe of liver, has 
duodenum and ascending colon in front. 

Describe the right ventricle of the heart. 

Is placed mostly upon anterior aspect of heart, does not 
extend to apex, is crescentic in cross-section, contains tricuspid 
valve, which guards right auriculo-ventricular opening, to 
left and front of which is conus arteriosus leading up to pul- 
monary orifice, which is guarded by pulmonary semilunar 
valves, contains columnar carnece, musculi papillares and 
chordse tendinea?. 

Describe endothelium. 

Irregular, flattened (squamous) cells, attached edge to edge, 
resting on basement membrane. 

Describe the external carotid artery. 

One of the two terminal branches of common carotid, given 
off at level of upper border of thyroid cartilage, extends up 
neck, passes into parotid gland, where it terminates by divid- 
ing into superficial temporal and internal maxillary arteries. 
Branches are: Ascending pharyngeal, to lateral wall of 
pharynx; superior thyroid, to larynx and thyroid body; lin- 
gual, to tongue; facial, to superficial parts of face; occipital, 
to post-cervical and occipital regions; posterior auricular, to 
external and middle ear; superficial temporal, to scalp; in- 
ternal maxillary, to deep parts of face and by middle menin- 
geal (through foramen spinosum of sphenoid), to inner skull 
wall and dura. 



4 ANATOMY. 

What muscles form the calf of the leg? Describe any 
one of these muscles. 

Gastrocnemius and soleus. Gastrocnemius takes origin by 
two heads from internal and external condylar ridges of 
femur; these heads unite, join the soleus, thus forming the 
tendo Achillis, which is inserted into the posterior extremity 
of the os calcis. 

Describe the thyroid gland. 

It consists of right and left lobes connected by an isthmus 
across 2d, 3d and 4th rings of trachea; has a capsule and 
trabecular enclosing closed follicles, which contain colloid 
material. 

Give a comprehensive description of any one of the 
long bones of the body. 

The humerus possesses a shaft and two extremities. The 
upper end has a head which is hemispherical and articulates 
with glenoid cavity of scapula. Just below it is the anatom- 
ical neck, to which the capsule of the shoulder- joint is at- 
tached. Then come the greater and lesser tuberosities, serving 
for the attachment of muscles, while below them is the surgical 
neck. The bicipital groove and ridges extend downward 
between the two tuberosities, and also serve for the insertion 
of muscles. Upon the posterior surface of the shaft is the 
musculo-spiral groove. Rough impressions are found upon 
the outer and inner aspects of the shaft for the deltoid and 
coraco-brachialis muscles respectively. The lower end is ex- 
panded laterally, to receive the radius and ulna, and supports 
the outer and inner condyles. The articular surface is di- 
vided into a capitellum externally for the head of the radius, 
and a trochlea internally for the greater sigmoid cavity of 
the ulna. Above the trochlear surface is the coronoid fossa 
anteriorly, and the olecranon fossa posteriorly. 

Into what two great classes are muscles divided? Give 
a macroscopic and a microscopic description of each. 

Voluntary and involuntary. The voluntary muscles num- 



ANATOMY. 5 

ber about 311 in the body. The fibres are bound into bundles 
by connective tissue (perimysium), and are attached to bones, 
ligaments or integument by bands of white fibrous tissue 
called tendons. The involuntary muscular tissue is found 
throughout the greater part of the wall of the alimentary 
tract, in the walls of the arteries and veins, and in the uterus. 
The microscopic appearance of a voluntary fibre is one that 
is transversely striated, with a sarcolemma (sheath) inclosing 
the sarcous elements. The involuntary fibre is fusiform, is 
longitudinally striated, and possesses a centrally placed 
nucleus. 

Describe the right and the left subclavian vein. 

The right subclavian vein rests on the first rib in front of 
the scalenus anticus muscle, and is a continuation of the 
axillary vein; just below and behind the sterno-clavicular 
joint it unites with the internal jugular vein to form the right 
innominate vein. The left subclavian vein does not differ 
materially from the right; at the junction of subclavian and 
internal jugular on the left side the thoracic duct terminates. 
The subclavian veins receive the blood from the upper ex- 
tremities, shoulders, chest wall and superficial area of face 
and neck. 

Mention the flexor muscles of the forearm and describe 
one of them. 

Flexor carpi radialis, flexor carpi ulnaris, flexor sublimis 
digitorum, flexor profundus digitorum, flexor longus pollicis. 
Flexor profundus digitorum takes origin from upper % of 
shaft of ulna, from coronoid process and from interosseous 
membrane ; is inserted by 4 tendons into last phalanx of each 
finger; action, to flex last phalanx. 

Compare aponeuroses with tendons. 

Aponeuroses are broad, flat sheets of fibrous tissue to which 
muscular fibres are attached, serving as tendons of insertion 
for these fibres. Tendons are rounded (cord-like) or narrow 
(ribbon-like) bundles of fibrous tissue attaching muscles to 
bones or forming ligaments of joints (shoulder, hip). 



6 ANATOMY. 

Give the number of the cervical vertebrae and mention 
the marked characteristics of such of these vertebrae as 
are in any way peculiar. 

Seven. The atlas is a ring with two lateral masses sup- 
porting a superior and an inferior pair of articular processes ; 
it has no spinous process; the axis has an odontoid process 
on the upper surface of its body ; the 7th vertebra has a long 
spine, hence its name, the vertebra prominens. 

Name the bones of the head. 

Occipital, 2 parietals, frontal, 2 temporals, sphenoid, eth- 
moid, 2 nasal, 2 lachrymal, 2 inferior turbinals, vomer, 2 
maxillae, 2 palate, 2 malar, mandible. 

Describe the acetabulum. 

Is formed by union of ilium, ischium and os pubis; has 
horseshoe-shaped articular surface and non-articular depres- 
sion at bottom ; cotyloid notch is below and in front ; is deep- 
ened by cotyloid ligament in recent state attached to rim. 

Name the seven muscles of the orbit. 

Levator palpebral superioris, superior, inferior, external, 
internal recti, superior and inferior oblique. 

Where is the compressor urethrae muscle? 

Between the two layers of triangular ligament and sur- 
rounds membranous urethra. 

Describe the origin and distribution of the optic nerves. 

They arise from the optic commissure, pass out of cranial 
cavity with ophthalmic artery through optic foramen, pierce 
sclerotic and choroid coats of eyeball to nasal side of posterior 
pole and are distributed to retinae. 

What is the solar plexus? 

A neuro-ganglionic collar of the sympathetic nervous system 
surrounding coeliac axis, from which nerve trunks accompany 
arterial branches to supply all abdominal viscera. 



ANATOMY. 7 

Describe the vagina. N 

Begins at vulvar aperture, extends upward and backward 
in axis of outlet of pelvis, surrounds cervix uteri, reaching 
higher up on cervix posteriorly than anteriorly, is lined with 
laminated squamous cells, has large venous plexuses in sub- 
mucosa, contains circular (within) and longitudinal (with- 
out) involuntary muscle fibres. Bladder and urethra are in 
front, rectum is behind. Peritoneum covers upper posterior 
wall. 

Differentiate synarthrosis, amphiarthrosis, and diarth- 
rosis, giving an example of each. 

Synarthrosis is an immovable joint consisting of two bones 
placed edge to edge with little or no fibrous tissue intervening; 
example, lambdoid suture. Amphiarthrosis is joint permit- 
ting of slight motion, made up of two bones with intervening 
fibrocartilaginous plate or disk and held together by liga- 
ments; example, joints formed by bodies of vertebrae and 
intervertebral disks. Diarthrosis is freely movable joint, 
consisting of two or more bones with articular surfaces cov- 
ered with hyaline cartilage and surrounded by ligaments lined 
with synovial membrane; example, hip- joint. 

Describe the shoulder=joint. 

Variety, enarthrodial (ball-and-socket) ; bones, glenoid 
fossa of scapula, head of humerus ; ligament, capsular, which 
is intimately blended with tendons of insertion of sub-scapu- 
laris, supraspinatus, infraspinatus and teres minor muscles; 
tendon of long head of biceps passes within capsule over 
humeral head, and is surrounded by synovial membrane; 
movements, flexion, extension, abduction, adduction, rotation 
and circumduction. 

Give the origin, insertion, action and nerve supply of 
any one of the following muscles: superior oblique, mas- 
seter, trapezius. 

Trapezius, origin from external occipital protuberance, 
inner third of superior curved line of occipital bone, liga- 



8 ANATOMY. 

mentum nuchas, spine of seventh cervical vertebra, spines of 
all thoracic vertebras; insertion into posterior border, outer 
third of clavicle, inner margin of acromion and entire upper 
border of spine of scapula ; action, to retract head, to approxi- 
mate scapulas, to elevate point of shoulder, to assist serratus 
magnus in rotating scapula, as in act of carrying arm to up- 
right vertical position; nerves, spinal accessory, third and 
fourth cervical. 

Give the origin, main branches and relations of any 
one of the following arteries: external carotid, axillary, 
femoral. 

Axillary artery is continuation of subclavian from outer 
border of 1st rib, extends to lower border of axilla (teres 
major muscle) in line indicated by coraco-brachialis muscle 
(inner border), lying behind and above axillary vein; outer 
cord of brachial plexus is above it, inner cord is below it, 
posterior cord is behind it, median nerve lies upon it; pecto- 
ralis minor muscle crosses it in front, pectoralis major is ante- 
rior to first and third portions; branches are superior tho- 
racic, acromial thoracic, long thoracic, alar thoracic, sub- 
scapular, anterior and posterior circumflex. 

Describe the course of the nerve fibres in the optic 
commissure. 

Fibres upon its posterior surface (Gudden's commissure) 
have nothing to do with sight, and unite posterior quadri- 
geminal bodies (testes) ; middle fibres decussate, those from 
right optic tract passing to left optic nerve and vice versa, 
to terminate in nasal half of retina ; outermost fibres of each 
tract do not decussate, but pass into optic nerve to be dis- 
tributed to temporal half of retina of same side. 

Give the origin, course and distribution of the great 
sciatic nerve. 

Origin from lower lumbar and upper sacral nerves (sacral 
plexus) ; course, through great sacro-sciatic foramen below 
pyriformis muscle, from beneath lower margin of gluteus 



ANATOMY. 9 

maximus midway between trochanter major and tuber ischii, 
rests upon adductor magnus and divides about middle of thigh 
into internal and external popliteal nerves ; it supplies semi- 
tendinosus, semimembranosus, adductor magnus and biceps. 
Internal popliteal is continued down leg as posterior tibial, 
distributed to back of leg and sole of foot ; external popliteal 
curves around below head of fibula to front of leg, becoming 
anterior tibial to front of leg and dorsum of foot. 

Describe the great omentum. 

Made up of double fold of peritoneum, extending from 
greater curvature of stomach downward for variable distance, 
then returning, surrounds transverse colon. It contains be- 
tween its layers more or less adipose tissue. 

Give the gross and the topographic anatomy of the 
pancreas. 

The "abdominal salivary gland" is located in upper pos- 
terior part of abdomen, behind stomach, in front of vertebral 
column and left kidney, and to right of spleen. Is elongated, 
soft in consistency, made up of lobules held together by con- 
nective tissue, is pinkish in color, and is divided into tail, 
body and head, the latter embraced by curve of duodenum. 
Is supplied by branches from splenic artery, which courses 
along upper border. Its duct, extending throughout the 
length of the gland, terminates with common bile duct in 
descending portion of duodenum. 

Locate and describe the pericardium. 

Fibro-serous sac surrounding heart, pyramidal, with base 
attached to central tendon of diaphragm, apex corresponding 
to great vessels at base of heart, and connected with deep 
cervical fascia by fibrous prolongations upward. Outer layer 
fibrous, lined with parietal serous layer, which is reflected 
upon heart and vessels at its base, constituting the visceral 
layer. 



10 ANATOMY. 

Describe and give the anatomical relation of the ap= 
pendix vermiformis. 

Is Sy 2 to 4^/2 inches long, made up of inner mucous coat, 
which is thickly set with simple, tubular glands (crypts of 
Lieberkuhn) and covered with columnar epithelium, beneath 
which is a thick layer of adenoid tissue, diffused and collected 
into closed follicles; outside of mucous membrane is sub- 
mucosa, with plexuses of vessels and nerves; next comes 
muscular layer, having thick, inner circular and thinner, 
outer longitudinal layer; the peritoneum surrounds the ap- 
pendix and forms a meso-appendix, usually extending along 
one-half the length of the organ; in this the appendicular 
artery (branch of ileo-oolic) courses; arterial supply is of the 
end-artery variety; the nerves are branches of the superior 
mesenteric plexus of the sympathetic system. The appendix 
is attached to the cecum, usually depending from its inner 
and posterior aspect, not far from ileo-caecal junction ; it may 
extend in any direction. In the female a fold of peritoneum 
is continued from the broad ligament to the meso-appendix 
(appendiculo-ovarian ligament), and conveys a branch of the 
ovarian artery. 

Describe Poupart's ligament, naming its anatomical re= 
Iations and uses as a surgical guide. 

Is formed by aponeurosis of external oblique muscle blend- 
ing with fascia lata, and extends, slightly curved downward, 
from anterior superior iliac spine to pubic spine; a reflected 
portion, Gimbernat's ligament, is attached to pubic end of 
iliopectineal line, forming inner margin of femoral (crural) 
ring (neck of femoral hernia). Beneath Poupart's ligament 
external cutaneous nerve, ilio-psoas muscle, anterior crural 
nerve, femoral artery and vein are located; above and to 
outer side of pubic spine it forms outer pillar of external 
inguinal ring. 

Describe the femoral artery and its branches. 

Begins as continuation of external iliac beneath middle of 



ANATOMY. 11 

Poupart's ligament, extends downward, bisecting Scarpa's 
triangle, through Hunter's canal, at lower end of which it 
becomes the popliteal. Branches are superficial epigastric, 
superficial circumflex iliac, superficial and deep external 
pudic, profunda, anastomotica magna, muscular. 

Name the principal lobes of the brain and the fissures 
dividing them. 

Frontal, parietal, temporal, occipital, central (island of 
E-eil). Fissure of Rolando separates frontal from parietal; 
fissure of Silvius separates frontal and parietal from tem- 
poral; parieto-occipital fissure separates parietal from occip- 
ital ; central lobe is found deeply placed in Sylvian fissure. 

Name the twelve pairs of cranial nerves. 

Olfactory, optic, motor oculi, trochlear, trigeminal, abdu- 
cens, facial, auditory, glossopharyngeal, pneumogastric, spi- 
nal accessory, hypoglossal. 

Name the bones articulating with the humerus. 

Scapula, radius, ulua. 

Describe the Eustachian tubes. 

Two tubes connecting middle-ear with naso-pharynx. 
Pharyngeal orifice is usually vertical slit just above floor of 
nasal chamber, behind posterior naris, and bounded poste- 
riorly by "cushion" of pharynx. Tube is formed by tem- 
poral bone in angle between squamous and petrous portions, 
and by coiled plate of cartilage attached to edge of bony part 
of tube; is lined with ciliated columnar epithelium. 

Describe the diaphragm, its principal openings and 
nerve supply. 

Dome-shaped muscle, origin from inner surface of last six 
costal cartilages, posterior surface of ensiform cartilage, by 
two crura from bodies of lumbar vertebrae (2d to 4th), from 
ligamenta arcuata, external and internal. Insertion into 
aponeurotic central tendon, which consists of three leaflets. 
Aortic opening is between crura, and transmits aorta, thoracic 



12 ANATOMY. 

duct and vena azygos major; esophageal opening is anterior 
and slightly to left of vertebral 'column, transmitting eso- 
phagus and both pneumogastric nerves; caval opening is in 
right leaflet of central tendon, and to its margins the outer 
coat of inferior cava is attached. Nerve supply, both 
phrenics. 

Describe the broad ligaments of the uterus and their 
anatomical relations. 

Double folds of peritoneum attached to floor and lateral 
margins of true pelvis, covering uterus anteriorly and pos- 
teriorly, reflected from it to bladder in front and to vagina 
behind. Between its layers are found Fallopian tubes, round 
ligaments, utero-ovarian ligaments, uterine and ovarian 
arteries and veins, lymphatics, and fetal relics. The ovaries 
are attached to it behind, near the pelvic brim. 

Describe the crystalline lens, and state what tissues are 
in contact with it, and how. 

Is a transparent, biconvex body, convexity being greater 
upon posterior surface than upon anterior; is contained in 
capsule, which is elastic; -it consists of lens-fibres, which are 
derived from epithelial cells (ectoderm), arranged in layers, 
which are of softer consistency near the surface (cortex), 
more compact and dense at the center (nucleus). It is non- 
vascular in the adult, its nutrition being maintained by inter- 
cellular transmission of nutritive fluids. Its suspensory lig- 
ament is formed by hyaloid membrane enclosing the vitreous, 
and is attached to lens capsule. The lens rests in patellar 
fossa of vitreous, iris (pupillary margin) rests upon its ante- 
rior surface, and ciliary processes are in relation with its 
circular edge. 

Give a brief description of the membranes of the brain. 

The dura lines the cranial cavity, is adherent to the vault, 
sides and base, and sends processes between cerebral hemis- 
pheres (falx cerebri), between cerebrum and cerebellum 
(tentorium cerebelli), and between hemisphere of cerebellum 



ANATOMY. 13 

(falx cerebelli) ; it splits to form spaces for the intima of 
veins, known as venous sinuses. The arachnoid, between dura 
and pia, is thin and delicate, and contains spaces for cerebro- 
spinal fluid, best developed at base of brain. The pia closely 
invests the encephalon, dipping into fissures and sulci, send- 
ing arterial branches into cerebral substance and receiving 
veins from same, and passes through transverse fissure into in- 
terior of brain, constituting velum interpositum, and furnish- 
ing choroid plexuses of ventricles. 

Describe the gross anatomy of the larynx. 

Consists of cartilaginous framework, ligaments, muscles, 
and is lined with mucous membrane. Cartilages are thyroid, 
cricoid, two arytenoids, two cornicula laryngis and epiglottis. 
Thyroid is shield-shaped, projects forward as pomum Adami ; 
cricoid is ring-shaped, is placed below thyroid, is broad pos- 
teriorly and supports arytenoids, one on each side of posterior 
quadrilateral portion. Epiglottis is attached by stem to angle 
of thyroid, and is directed upward over entrance to larynx. 
Crico-thyroid membrane extends from cricoid cartilage up- 
ward within thyroid, and by rounded, free edge forms true 
vocal bands, which extend between thyroid anteriorly and 
vocal processes of arytenoids posteriorly. Lateral crico- 
arytenoid muscles approximate vocal bands, posterior crico- 
arytenoid muscles separate them. Superior laryngeal artery 
pierces thyrohyoid membrane to supply interior of larynx; 
supeior laryngeal nerve is nerve of sensation to mucous 
membrane, and recurrent laryngeal is motor nerve to all mus- 
cles but one (crico-thyroid) supplied by superior laryngeal. 

Minutely describe the relations of the peritoneum to 
the bladder. 

Covers upper surface and sides, reflected on to rectum in 
male and vagina in female; leaves anterior abdominal wall 
just above symphysis to form loose fold between bladder and 
symphysis, then passing to summit of bladder without cover- 
ing its anterior wall, thus forming prevesical space (space of 
Retains). 



14 ANATOMY. 

Describe the endocardium. 

Is continuous with the tunica intima of the vessels at the 
base of the heart, lines both auricles and both ventricles, and 
forms, strengthened by fibrous tissue, the several valves of 
the heart. 

What parts of the brain does the Pons Varolii connect? 

Cerebellum with posterior quadrigeminal bodies (testes), 
one cerebellar hemisphere with the other, parts below (cord 
and medulla) with cerebral hemisphere above. 

Name the ganglia connected with the 5th pair of cranial 
nerves. 

G-asserian, ophthalmic, spheric-palatine (Meckel's), otic r 
submaxillary. 

Give an anatomical description of the bronchial tubes. 

Formed by division of trachea; right and left bronchial 
tubes pass into right and left lungs respectively at root of 
lung, dividing and subdividing, finally becoming bronchioles. 
Each consists of rings or plates of cartilage held together by 
an elastic membrane, and are lined by mucous membrane 
possessing ciliated columnar epithelial cells in larger tubes 
and squamous cells in smallest tubes. 

Name the branches of the subclavian artery. 

Vertebral, internal mammary, thyroid axis (inferior thy- 
roid, transverse cervical, suprascapular), superior intercostal. 

Describe the inguinal canal. 

Is a flat-sided passage in the lower part of the inguinal 
region, extending between internal and external abdominal 
rings; its "floor" is formed by transversalis fascia meeting 
Poupart's ligament; its "roof" by conjoined tendon (internal 
oblique and transversalis muscles) ; interior wall by skin, 
superficial fascia, aponeurosis of external oblique, internal 
oblique; posterior wall by transversalis fascia, pre-peritoneal 
fat and peritoneum. Is about iy 2 inches long in adult, trans- 
mitting spermatic cord in male and round ligament in female. 



ANATOMY. 15 

Locate and describe the ileo=cecal valve. 

Is found at junction of ileum with cecum, formed by 
ileum passing upward and outward to the right to meet large 
bowel obliquely; its orifice is a horizontal slit projecting into 
cecal lumen. 

Describe either the ascending or descending vena cava* 

Ascending vena cava is formed by union of the two common 
iliac veins upon body of fifth lumbar vertebra, passes upward, 
resting on bodies of vertebra to right of aorta, pierces dia- 
phragm at caval opening, and almost immediately enters right 
auricle. Its tributaries are lumbar veins, right spermatic 
vein (or ovarian), renal veins, hepatic veins, phrenic veins. 

Name the bones that form the ankle= joint and give their 
relations. 

Tibia and fibula above, with internal and external malleoli, 
respectively, forming mortise for astragalus, whose trochlear 
surface and sides fill up the space between the two bones of 
the leg. 

What muscles form the quadriceps extensor crureus and 
where is its conjoined tendon inserted? 

Rectus femoris, vastus externus, vastus internus, crureus^ 
tendon is inserted into tubercle of tibia. 

With what bones does the malar articulate? 

Frontal, superior maxilla, temporal, sphenoid. 

What arteries supply the bladder in the male, and from 
what are they branches? 

Superior, middle and inferior vesicle, branches of anterior 
trunk of internal iliac. 

In an amputation of the forearm, 3 inches above the 
wrist, what arteries will it be necessary to tie, and of 
what are they branches? 

Radial and ulnar arteries, branches of the brachial ; interior 
and posterior interosseous arteries, branches of the ulnar. 



16 ANATOMY. 

Locate the 4th ventricle of the brain. 

Floor is formed by medulla and pons, borders by inferior 
and superior peduncles of cerebellum, with middle peduncles 
at lateral angles; roof is formed by valve of Vieussens, or 
superior medullary velum, above, inferior medullary velum 
and tela choroidea inferior below. 

Locate and briefly describe the gall=bladder. 

Is placed upon under surface of right lobe of liver, is so- 
called fissure for gall-bladder; fundus projects beyond ante- 
rior border of liver. Is a pear-shaped sac covered by perito- 
neum, having a rounded end called the fundus, and a 
constricted posterior extremity known as the neck, which is 
continued into the cystic duct. Its wall is composed of 
fibrous and muscular tissue, and it is lined with mucous 
membrane, which is thrown into cork-screw-like folds at the 
neck and beginning of the cystic duct. 

Describe the esophagus as to (a) location, (b) dimen= 
sions, (c) arterial supply. 

Is located behind trachea, and in posterior mediastinum, 
extending from lower end of pharynx to cardiac end of stom- 
ach at esophageal orifice of diaphragm. It is 10 inches long ; 
its arterial supply is by branches from the inferior thyroid 
(thyroid axis of subclavian), thoracic aorta, gastric (coeliac 
axis), left phrenic. 

Describe the rectum as to structure, length and con= 
tained glands. 

Extends from third piece of sacrum to anus, curved for- 
ward. From third piece of sacrum to tip of coccyx is par- 
tially covered by peritoneum. Its walls consist of peritoneum 
or fibrous tissue externally, within which is muscular coat of 
longitudinal and, circular fibres; then comes submucosa sup- 
porting mucous membrane:, the latter forming fixed, trans- 
verse folds (plicae recti, or valves of Houston), two or three 
in number, extending transversely around portion of rectum. 
Glands are of mucous variety. 



ANATOMY. 17 

Name the foramina at the base of the skull, and the 
structures transmitted through each. 

Foramen magnum : Spinal cord, meninges, spinal accessory 
nerves, vertebral arteries. Posterior condyloid (inconstant) : 
Veins. Anterior condyloid (2) : Hypoglossal nerves. Mas- 
toid: Emissary vein. Internal anditory meatus: Auditory 
and facial nerves, auditory artery. Jugular foramen : Lateral 
and inferior petrosal sinuses, glossopharyngeal, pneumogas- 
tric and spinal accessory nerves. Hiatus Fallopii : Great 
superficial petrosal nerve. Middle lacerated foramen: In- 
ternal carotid artery, sympathetic plexus. Foramen spino- 
sum : Middle meningeal artery. Foramen ovale : Mandibular 
division of sensory root of fifth cranial nerve and motor root 
of fifth. Foramen rotundum: Maxillary division of fifth. 
Vidian canal: Vidian nerve. Optic foramen: Optic nerve 
and ophthalmic artery. Sphenoidal fissure: Motor oculi, 
trochlear and abducens nerves, ophthalmic division of fifth, 
ophthalmic vein. Olfactory foramina : Olfactory nerves. 

Describe the female urethra as to (a) location, (b) 
dimensions, (c) structure. 

Is located anterior to vagina, extending from internal uri- 
nary meatus (neck of bladder) to external urinary meatus 
in vestibule, close to anterior margin of vaginal orifice. It 
is iy 2 inches long and quite dilatable. Is lined with mucous 
membrane (squamous epithelium, stratified) which is thrown 
into longitudinal folds, and is surrounded by an areolar coat 
and by muscular layers containing inner longitudinal and 
outer circular fibres, with an abundance of yellow elastic 
tissue and many vessels, especially veins. 

What is contained in the right hypochondriac region? 

Part of right lobe of liver, part of gall-bladder, part of 
ascending colon, hepatic flexure, part of right kidney. 

What muscles form the tendo Achillis, and where is the 
tendon inserted? 

Gastrocnemius and soleus; inserted into posterior part of 
os calcis. 
2 



18 ANATOMY. 

What forms the internal malleolus of the ankle=joint? 
The lower end of the tibia- 
Describe the bones of the foot, giving their divisions 
and articulations. 

Tarsus consists of os calcis, astragalus, cuboid, scaphoid, 
cuneiform bones, (internal, middle and external) ; metatarsus 
consists of five bones; phalanges number fourteen. Astra- 
gulus articulates with tibia, fibula, os calcis, scaphoid. Os 
calcis articulates with astragalus, cuboid. Scaphoid articu- 
lates with astragalus and three cuneiform bones. Cuneiform 
bones articulate with scaphoid behind, with each other lat- 
erally, and with first, second, third and fourth metatarsal 
bones in front. Metatarsals articulate with three cuneiform 
and cuboid behind, with each other, and with first phalanges. 
Phalanges articulate with metatarsals and with each other. 

Name the articulations of the occipital bone. 

Atlas, two parietals, two temporals, sphenoid. 

What are the special characteristics of the left ven= 
tricle of the heart? 

It forms the apex of the heart ; its wall is thicker than that 
of the right ventricle; its musculi papillares are fewer in 
number and larger; auriculo- ventricular valve (mitral) is 
made up of two segments. 

Describe the auditory apparatus. 

Consists of three divisions, viz., external, middle and in- 
ternal ear. Auricle is attached to temporal bone, is made 
up of elastic cartilage, leads into external auditory meatus, 
at bottom of which is obliquely placed membrana tympani. 
Middle ear is narrow cavity in petrous bone, Eustachian 
tube connecting it with the naso-pharynx ; mastoid antrum 
is. in upper posterior part, leading into mastoid cells ; it is 
lined with mucous membrane. The internal ear consists of 
osseous labyrinth containing membranous labyrinth, and is 
made up of vestibule, cochlea and three semicircular canals. 
To membranous labyrinth auditory nerve is distributed. 



ANATOMY. 19 

With what bones does the radius articulate? 

Humerus, ulna, scaphoid and semilunar. 
Name the branches of the abdominal aorta. 

Two phrerrics, coeliae axis (brs. gastric, hepatic, splenic) , 
superior and inferior mesenteric, suprarenals, renals, lumbar 
arteries (4), spermatic or ovarian, middle sacral and right 
and left common iliacs. 

What are the anterior and posterior boundaries of the 
axilla, and what arteries and nerves pass through it? 

Anterior boundary: Pectoralis major and minor. Poste- 
rior boundary: Subscapularis, teres major and latissimus 
dorsi. Arteries passing through: Axillary and its branches 
(superior thoracic, acromial thoracic, long thoracic, alar tho- 
racic, subscapular, anterior and posterior circumflex). 
Nerves passing through : Brachial plexus, consisting of outer, 
middle and inner cords, with branches as follows: Mus- 
culo- cutaneous, internal and lesser internal cutaneous, cir- 
cumflex, ulnar, musculo-spiral, median. 

Give the origin and distribution of the third division 
of the fifth pair of nerves. 

Origin : From Gasserian ganglion at apex of petrous bone, 
passes through foramen ovale with motor root, with which it 
now unites; divided into anterior and posterior divisions, 
anterior being mostly motor to muscles of mastication (tem- 
poral, pterygoids, masseter), posterior division forming infe- 
rior dental, which furnishes mylo-hyoid to muscle of same 
name, branches to teeth, incisor and mental branches; auri- 
culotemporal, sensory to ear and temple; lingual, which re- 
ceives chorda tympani branch of facial and is distributed to 
tongue. 

Bound Scarpa's triangle, and mention the vessels and 
nerve in it. 

Is bounded by Poup art's ligament above, sar tonus exter- 
nally, adductor longus internally; vessels are common and 



20 ANATOMY. 

superficial femoral, profunda femoris arteries; femoral vein; 
nerve is anterior crural. 

Give the location and describe the anatomical struc- 
ture of the kidneys. 

Are placed in loins, resting upon psoas magnus and quad- 
ratic lumborum muscles, upper end of left reaching as high 
as upper border of 11th rib, upper end of right as high as 
lower border of 11th rib. Each is capped by suprarenal body, 
is surrounded by capsule and perirenal connective tissue con- 
taining fat, is supplied by renal artery, and drained by renal 
vein and lymphatics; nerves from renal plexus of sympa- 
thetic system. The kidney is bean-shaped, notch upon inner 
border is called the hilum, leading into a depression or 
cavity known as the sinus; here the renal duct, or ureter, 
begins and the vessels and nerves enter or leave. The interior 
of the gland consists of a connective tissue parenchyma sup- 
porting vessels and uriniferous tubules, arranged as cortex 
and medulla; the cortex contains the glomeruli (coiled-up 
blood vessel — "little ball of yarn") and some of the tubules; 
the medulla consists of pyramids (Malpighian or medullary) 
made up of parallel collecting tubules, which terminate upon 
the apex of the pyramid, pouring urine into the calices of the 
"pelvis of the kidney," the upper expanded portion of the 
ureter. The uriniferous tubules begin around a glomerulus 
as a closed extremity (capsule of Bowman), then pass tor- 
tuously through the cortex down into the medulla and back 
again into the cortex (loop of Henle), terminating in one of 
the collecting tubules found in the pyramid of Ferrein, whose 
base is in apposition with the base of a medullary pyramid. 

Describe the mesentery. 

Is a double fold of peritoneum attached to posterior ab- 
dominal wall in an oblique line extending between the left 
side of the body of the second lumbar vertebra to the right 
sacro-iliac joint, a distance of about eight inches. Between 
its two layers are found arteries, veins, lymphatics (lacteals), 
lymphatic nodes (mesenteric "glands"), and more or less 



ANATOMY. 21 

fat; to its expanded, convoluted edge the small intestine is 
attached, the mesenteric layers surrounding it and constitut- 
ing its serous covering. 

Give the name and location of the various glands found 
in the small intestine. 

Glands in small intestine: Duodenal ("Bruner's"), in 
duodenum; intestinal follicles ("crypts of Lieberkuhn"), in 
whole length of small and large intestine ; solitary glands, in 
wall of small intestine, collected into colonies in ileum, then 
known as Peyer's patches. 

Give a brief yet comprehensive description of the heart. 

Base corresponds to upper level of third costal cartilage, 
one inch to right of sternal margin and one-half inch to left ; 
apex to fifth intercostal space just internal to vertical line 
drawn through left nipple ; base is directed upward and back- 
ward to the right, apex downward, forward and to the left. 
Is surrounded by fibro-serous sac called pericardium, consist- 
ing of two layers, fibrous externally, serous internally, the 
latter lining sac (parietal layer) and covering heart (visceral 
layer), it is attached to central tendon of diaphragm. 
Right auricle has openings of superior and inferior venae 
cava? and coronary sinus; right ventricle receives blood from 
right auricle through right auriculo-ventricular opening 
(tricuspid valve), and expels it through conus arteriosus into 
pulmonary artery, which is guarded by pulmonary semilunar 
valve; right ventricle contains columnae carneae, musculi 
papillares, chordae tendineae attached to tricuspid valve seg- 
ments; left auricle has four openings for pulmonary veins 
and left auriculo-ventricular opening, guarded by mitral 
valve; left ventricle has columnae carneae, etc., like right, 
its wall is thicker ; it forms apex of heart, and blood leaves it 
by passing into aorta, which is guarded by aortic semilunar 
valve; coronary arteries (2), branches of aorta above semi- 
lunar valve, supply heart muscle. Heart is lined with endo- 
cardium. Pneumogastrics and cardiac plexuses of sympa- 
thetic nervous system supply heart. 



22 ANATOMY. 

What forms the external malleolus? 

Lower end of fibula. 

Describe one of the vertebrae. 

Consists of centrum, or body, projecting anteriorly, with 
arch behind, made up of two (lateral) pedicles, converging 
laminae to form spinous process, transverse process on each 
side, superior and inferior pair of articular processes, inter- 
vertebral notch on under side of each pedicle. 

Describe the position of the palmar arterial arches. 

Superficial palmar arch is placed upon tendons of flexor 
sublimis digitorum, extending across palm at level of line 
drawn transversely at angle of web between thumb and index 
finger; deep arch lies upon metacarpal bones and interossei 
muscles, one-half inch nearer carpus than superficial arch. 

What blood vessels pass to and from the liver? 

To it, hepatic artery, portal vein; umbilical vein in foetus; 
from it, hepatic veins. 

Describe the pyloric orifice of the stomach. 

Is directed backward and to right, is near neck of gall- 
bladder, consists of special thickening of stomach wall pro- 
duced by circular muscular fibres, which have sphincter-like 
action. 

What tissues of the abdominal wall are divided in the 
operation for appendicitis? 

Skin, superficial fascia, external oblique muscle, internal 
oblique and transversalis muscles, transversalis fascia (pre- 
peritoneal fat) , peritoneum. Or, skin, superficial fascia, linea 
semilunaris, transversalis fascia, peritoneum. 

With what bones does the frontal articulate? 

Both parietal, both malar, both nasal, both lachrymal, both 
maxillae (superior), ethmoid, sphenoid. 



ANATOMY. 23 

Describe the structure of the prostate gland and give 
its anatomical relations. 

It possesses a capsule of fibrous tissue, enclosing voluntary 
and involuntary muscle and branched tubular glands opening 
into prostatic urethra; base is closely applied to "neck" of 
bladder, circular muscular fibres of which are continued 
around prostatic urethra, which pierces prostate from base 
to apex; behind is rectum; in front is pubo-prostatie plexus 
of veins separating it from symphysis pubis; ejaculatory 
ducts pass through gland between middle and lateral lobes. 

With what bones does the clavicle articulate? 

Sternum, cartilage of first rib, scapula. 

Give the origin and distribution of the median nerve. 

Formed by branch from outer and one from inner cord of 
brachial plexus in axillary space, over front of axillary artery, 
is in close relation to brachial artery to bend of elbow, when 
branches are distributed to all superficial muscles in front of 
forearm except flexor carpi ulnaris; a branch known as ante- 
rior interosseous supplies outer half of flexor profundus, flexor 
longus pollicis and pronator quadratus (deep muscles) ; in 
the palm the median is distributed to integument of flexor 
surface of thumb, index, middle and middle-finger half of 
ring finger and their contiguous sides, and dorsum of distal 
segment of thumb and fingers (2%), motor branches to ab- 
ductor and opponens pollicis, superficial head of flexor brevis 
pollicis and two outer lumbricales. 

Where is the fissure of Sylvius and what artery does it 
contain? 

Begins at anterior perforated space, separates frontal and 
parietal lobes from temporal lobe, passes upward and back- 
ward to terminate in parietal lobe; contains middle cerebral 
artery. 

Name the branches of the brachial artery. 

Superior profunda, nutrient, muscular, inferior profunda, 
anastomotica magna, radial and ulnar (terminals). 



24 ANATOMY. 

Name the component parts of the spermatic cord. 

Spermatic artery, spermatic veins (pampiniform plexus), 
vas deferens, deferential artery and deferential veins, lym- 
phatics, nerves (spermatic plexus of sympathetic). 

What forms the internal hamstrings? 

Tendons of semitendinosus, semimembranosus, gracilis. 

Describe the location of the intercostal arteries. 

In the intercostal groove near the lower border and inner 
surface of the rib; anteriorly it occupies the upper part of 
the intercostal space. 

What bone forms the heel and with what does it artic= 
ulate? 

Os calcis ; with astragalus and cuboid. 

What arteries supply the heart with blood, and where 
do they originate? 

Coronary (2), springing from arch of aorta just above 
sinuses of Valsalva of aortic semilunar valve. 

Name the structures located in the inguinal canal and 
give their anatomical relations. 

Spermatic cord in male, round ligament in female. Are in 
relation with walls of inguinal canal, which are, anterior, 
external oblique aponeurosis entire length, conjoined tendon 
(internal oblique, transversalis) for outer third; posterior, 
transversalis fascia and, at inner end, insertion of conjoined 
tendon; floor is formed by Poupart's ligament and trans- 
versalis fascia; roof by arched fibres of conjoined tendon. 

Describe the thoracic duct. 

Begins upon body of second lumbar vertebra in dilated 
pouch called receptaculum chyli, passes through aortic open- 
ing in diaphragm, then through posterior mediastinum, and 
at base of neck arches to left, terminating at junction of left 
subclavian and internal jugular veins. It drains the lymph 
from all parts of body except right upper extremity, right 



ANATOMY. 25 

side of head and neck, right half of thorax (right lung and 
right side of heart) and upper surface of liver. 

Describe the pleura. 

A closed serous sac lining the thoracic wall (parietal layer), 
from which it is reflected to the lung, investing it (visceral 
layer), dipping into the fissures and sending process from 
root of lung to diaphragm (ligamentum latum pulmonis) . 

Name the seven openings into the pharynx. 

Two posterior nares, two Eustachian orifices, mouth, larynx, 
esophagus. 

Locate and describe the spleen. 

Is in the left hypochondriac region, dorsally, to left of 
fundus of stomach and to left of tail of pancreas ; is in con- 
tact with under surface of diaphragm, which separates it 
from 8th, 9th, 10th and 11th ribs. It has convex outer sur- 
face, antero-internal and postero-internal surfaces, is entirely 
covered by peritoneum, at hilum splenic artery breaks 
up into branches to enter gland (ductless) and splenic 
vein leaves interior. Anterior border is notched; capsule 
invests it and sends trabecular into interior at hilum, 
dividing it into compartments, or areolar, which contain 
splenic pulp. "Wall of arteriole becomes thickened with lym- 
phoid material, which thickenings are known as Malpighian 
corpuscles. Minute arterioles terminate abruptly in areolae, 
where blood mixes with splenic pulp. Color of spleen is 
purple. 

What bones make up the pelvis? Give the gross anat= 
omy of the bony pelvis. 

Two ossa innominata (ilium, ischium, os pubis), sacrum and 
coccyx. Bony pelvis consists of upper expanded portion 
called the false pelvis, and lower slightly cordiform cavity 
known as the true pelvis. The true pelvis has inlet, cavity 
and outlet, conjugate (antero-posterior), transverse and ob- 
lique diameters. 



26 ANATOMY. 

Mention the muscular and the ligamentous attachments 
of the patella. 

Quadriceps extensor femoris (rectus, vastus internus and 
externus, crureus) ; ligamentum patella?. 

Describe the wrist=joint. 

Is formed by radius and triangular cartilage above, sca- 
phoid, semilunar and cuneiform below. (Ulna is separated 
from cuneiform by triangular interarticular cartilage, hence 
is excluded from wrist-joint). Ligaments are anterior and 
posterior, external and internal lateral. Movements are 
flexion, extension, abduction, adduction, circumduction. 

What muscles assist in mastication? In deglutition? 

(a) Temporal, internal and external pterygoids, masseter. 
(b) Mylo-hyoid, digastric, stylo-hyoid (first part of act) ; 
omo-hyoid, stemo-hyoid, sterno-thyroid, thyro-hyoid (second 
part of act). 

State (a) the nerve supply of the rectum, (b) the blood 
supply of the rectum. 

(a) Sympathetic branches from inferior mesenteric and 
hypogastric; plexuses inferior hemorrhoidal, branch of in- 
ternal pudic. (b) Superior and middle hemorrhoidal arter- 
ies, branches of inferior mesenteric and anterior trunk 
of internal iliac respectively; inferior hemorrhoidal, branch 
of internal pudic. 

Describe the internal jugular vein. 

Is formed just below jugular foramen by lateral and infe- 
rior petrosal sinuses;; courses down neck beneath anterior 
border of sterao-eleido-mastoid muscle, in a common sheath 
with the internal carotid (above), common carotid (below), 
and pneumogastric nerve, the latter behind and between, and 
the artery to the inner side of the vein, which partially over- 
laps the artery. Behind sternal end of clavicle it unites with 
subclavian to form innominate vein. 



ANATOMY. 27 

Give the course and relations of Stenson's duct. 

Is formed in parotid gland, emerges from its anterior bor- 
der, resting upon masseter muscle a finger's breadth below 
zygoma; it then perforates buccinator muscle, runs forward 
and pierces mucous membrane of cheek wall opposite upper 
middle molar tooth. 

Describe the Fallopian tubes and give their relations. 

Oviducts are attached to cornua of uterus, extend laterally 
to a point near pelvic brim, here expanding into fimbriated 
extremity; one of the fimbriae is attached to ovary (tubo- 
ovarian ligament). Each tube is lined with mucous mem- 
brane thrown into folds, possessing columnar, ciliated epithe- 
lium, outside of which is muscular coat of internal circular 
and external longitudinal fibers, the whole being covered 
by peritoneum of broad ligament. Ovarian and uterine 
arteries anastomose along their lower border; fimbriated ex- 
tremity is in close relation to ovary; outer part of broad 
ligament, extending from tube to pelvic wall, is called infun- 
dibulo-pelvic ligament, and contains ovarian artery and veins. 

Describe the dura mater. Mention the processes and 
sinuses of the dura mater. 

Forms the lining or endosteum of cranial cavity, and 
extends through foramen magnum into neural canal as ex- 
ternal layer of theca of cord; is tough and fibrous, forms 
projections or shelves in cranial cavity for support of 
encephalon. These are falx cerebri, falx cerebelli, tentorium 
cerebelli. Dura consists of two layers, endosteal and menin- 
geal, which separate at certain places to permit the entrance 
of the tunica intima of a vein, thus forming venous sinuses 
of cranium. These are superior and inferior longitudinal, 
straight, two lateral, occipital, two superior and inferior 
petrosal, .transverse, circular, and two cavernous. 

Give the macroscopic and the microscopic appearance of 
(a) kidney tissue, (b) lung tissue, (c) nerve fiber. 

(a) Kidney tissue is moderately firm, somewhat granular, 



28 ANATOMY. 

reddish-brown in color. Microscopically it presents glomer- 
uli, uriniferous tubules, blood vessels iand interstitial con- 
nective tissue, (b) Lung tissue is of a mottled pink color, 
soft and porous. Under the microscope it shows bronchioles 
(fibrous wall of elastic tissue lined with mucous membrane) 
and alveoli, dilatations lined with mucous membrane of squa- 
mous epithelial cells, outside of which are seen capillary blood 
vessels, (c) Nerve fibre is cord-like, soft and white. Histo- 
logically it consists of axis cylinder surrounded by white 
substance of Schwann (medullary substance) (absent in non- 
medullated nerves) and encased in the neurilemma. Inter- 
ruptions in the medullary substance occur (nodes of Ranvier) . 

What anatomic parts are normally found in the left 
hypochondriac region? 

Fundus of stomach, spleen and tail of pancreas, splenic 
flexure of colon, part of left kidney. 

Give in language or by drawing, the normal curvatures 
of the spinal column, and describe a typical cervical ver= 
tebra. 

Curves are cervical, thoracic, lumbar, sacro-coccygeal ; 
convexity is forward in cervical, backward in thoracic, 
forward in lumbar, backward in sacro-coccygeal. The line 
of gravity of the trunk passes through the chords of 
these curves. A typical cervical vertebra consists of a small 
body, diverging pedicles, a bifid spinous process, bifid trans- 
verse processes grooved on upper border, with a costo-trans- 
verse foramen for vertebral artery at base of transverse 
process; neural foramen is relatively large. 

Name the bones and ligaments of the ankle=joint. 

Tibia, fibula, astragalus; anterior and posterior, internal 
(deltoid) and external lateral ligaments. 

Name the principal muscles that keep the bo'dy erect 
on the thigh and give the origin and insertion of any one 
of them. 

Gluteus maximus, gluteus medius. gluteus minimus, ham- 



ANATOMY. 29 

strings; gluteus maxinms takes its origin from outer surface 
of ilium between posterior part of crest and superior gluteal 
line, from vertebral aponeurosis, two last pieces of sacrum, 
posterior surface of great sacro-sciatic ligament, and is in- 
serted into gluteal ridge of femur and ilio-tibial band of 
fascia lata. 

Give the origin, distribution and branches of the middle 
meningeal artery. 

Is branch of internal maxillary, passes through foramen 
spinosum of sphenoid, traverses wall of middle cranial fossa, 
dividing into anterior and posterior branches (meningeal) 
supplying dura and bony wall of cranium. 

Where does the glosso=pharyngeal nerve rise and what 
structures are supplied by this nerve and its branches? 

Arises from groove between olivary and restiform bodies, 
passes out of cranial cavity through jugular foramen, divides 
into lingual and pharyngeal branches, supplying mucous 
membrane of posterior part of tongue (circumvallate papillae) 
and mucous membrane of pharynx. A branch (Jacobson's) 
is distributed to tympanum. 

Describe the pharynx. 

Belongs to both respiratory and alimentary tracts, is lined 
with mucous membrane possessing ciliated columnar cells 
above, and squamous, stratified cells below level of soft palate ; 
pharyngeal aponeurosis is between mucous membrane and 
constrictor muscles; constrictor muscles are three in number, 
superior, middle, inferior. Pharynx is flattened antero-pos- 
teriorly, is widest opposite greater cornua of hyoid bone, and 
communicates with posterior nares, with middle ears by 
Eustachian tubes, with mouth, larynx and esophagus. The 
pharyngeal tonsil is located upon upper posterior wall, and 
consists of a special collection of adenoid tissue, which is 
found more or less freely distributed throughout naso- 
pharynx. 



30 ANATOMY. 

Name the regions of the abdomen. 

Draw transverse line through anterior superior iliac spines ; 
also through costal cartilages of 10th ribs; intersect with 
vertical lines through center of Poupart's ligament. Nine 
regions thus formed are, from above downward, right and 
left hypochondriac, epigastric, right and left lumbar, umbil- 
ical, right and left inguinal, hypogastric. 

Locate and describe the cecum. 

First part of large intestine, found below ileo-cecal junc- 
tion in right iliac fossa ; is entirely surrounded by peritoneum, 
possesses sacculations, that upon right side usually larger, 
thus throwing original (fetal) apex to left, at which point 
appendix vermiformis is attached. Longitudinal muscular 
bands well defined. 

Describe the eyeball and give its parts. 

Is spherical in shape, embedded in orbital fat, has ocular 
muscles attached to it, is perforated by optic nerve and ciliary 
arteries and veins, posterior five-sixths opaque, anterior one- 
sixth transparent. Its walls are made up of sclerotic and 
cornea, uveal tract (choroid) and retina, enclosing crystalline 
lens and vitreous body. Behind cornea is anterior chamber 
containing aqueous humor ; in front of crystalline lens is iris. 

Give the names of five muscles of the male perineum. 

Ischio-cavernosus, compressor urethras, bulbo-cavernosus, 
trans versus perinei, sphincter ani externus. 

Name five muscles of the back of the leg. 

Gastrocnemius, plantaris, soleus, tibialis posticus, flexor 
longus digitorum. 

Name the principal divisions and subdivisions of the 
internal carotid artery. 

It divides, after passing through cavernous sinus, into ante- 
rior and middle cerebral arteries; its subdivisions are oph- 
thalmic and posterior communicating. 



ANATOMY. 31 

How is the eye supplied with blood? 

By the ophthalmic artery, forming ciliary branches and 
arteria centralis retinae 

What is the circle of Willis? 

An arterial anastomosis at base of brain, formed by internal 
carotid arteries as follows: Each internal carotid sends for- 
ward the anterior cerebral, which is connected with the oppo- 
site anterior cerebral by the anterior communicating; it 
furthermore sends backward the posterior communicating 
which meets the posterior cerebral, which is a branch of the 
basilar. 

Name and bound the ventricles of the brain. 

The lateral ventricles (first and second) are bounded above 
by corpus callosum; below by intraventricular portion of 
corpus striatum, taenia semicircularis, choroid plexus, optic 
thalamus, posterior pillar of fornix, corpus fimbriatum; in- 
ternally by septum lucidum. Third is bounded above by 
velum interpositum ; below by gray matter at base of brain, 
i. e., lamina cinerea, tuber cinereum, corpora albicantia, pos- 
terior perforated space and tegmenta of crura cerebri ; later- 
ally by optic thalami; anteriorly by lamina cinerea and 
anterior pillars of fornix; posteriorly by posterior commis- 
sure and pineal gland (epiphysis cerebri). Fourth ventricle 
is bounded above by valve of Vieussens (superior medullary 
velum), in the middle by epithelial lining and pia; below 
by inferior medullary velum; floor is formed above by pons, 
below by medulla; sides are formed by superior, middle and 
inferior cerebellar peduncles. 

Describe the sympathetic nerve, naming and locating 
the principal ganglia. 

Consists of a double chain of ganglia extending along 
either side of vertebral column anteriorly, connected by 
branches with each other and with spinal nerves (rami com- 
municantes), furnishing branches to blood vessels (vaso- 
motor nerves) and forming plexuses — three prevertebral 



32 ANATOMY. 

plexuses and numerous secondary plexuses around arteries. 
Principal ganglia are ophthalmic, in back part of orbit; 
sphenopalatine, in spheno-niaxillary fossa; submaxillary, 
upon submaxillary gland; semilunar, upon aorta around 
coeliac axis. 

Give the origin, insertion and action of any one of the 
following muscles: occipito=frontalis, deltoid, gastrocne= 
mius. 

Deltoid arises from outer third anterior border of clavicle, 
outer margin of acromion, lower border of spine of scapula, 
entire length, and is inserted into deltoid impression upon 
outer surface of middle of shaft of humerus. Action, to 
abduct arm to horizontal position. Nerve, circumflex. 

What arteries unite to form the basilar artery? 

The two vertebrals. 
Describe the tongue. 

Consists of intrinsic and extrinsic muscles. Intrinsic are 
different divisions of lingualis (superior, inferior, transverse 
and vertical) ; extrinsic are geniohyoglossus, hyoglossus, 
styloglossus, palatoglossus. Tongue is supported by hyoid 
bone, is covered by mucous membrane thickly set with papillae, 
viz., circumvallate at base, fungiform and filiform upon dor- 
sum and margin. Nerves: Motor, hypoglossal; sensory and 
gustatory, glosso-pharyngeal. lingual, chorda tympaui. 

Describe the pia mater. 

Innermost of three meninges, is closely applied to central 
nervous system, supporting blood vessels, dipping down into 
sulci and passing into general ventricular cavity of ence- 
phalon to develop choroid plexuses — vascular fringes found 
in lateral, third and fourth ventricles. 

Describe the bones of the hand with their divisions and 
articulations. 

Carpus, metacarpus, phalanges. Eight carpal bones: Sca- 
phoid, semilunar, cuneiform, pisiform, trapezium, trapezoid, 



ANATOMY. 33 

os magnum, unciform. Five metacarpal bones; fourteen 
phalanges. Carpal articulate with each other and with bases 
of metacarpals ; scaphoid and semilunar articulate with ra- 
dius; cuneiform with triangular interarticular cartilage be- 
tween it and ulna- metacarpals articulate with each other at 
their bases and with first phalanges at their heads ; phalanges 
articulate with each other and with metacarpals. 

Describe the hip=joint. 

Enarthrodial, or ball-and-socket joint, formed by acetab- 
ulum and head of femur, surrounded by capsule, most im- 
portant and strongest part of which is found upon the anterior 
aspect of the joint, extending between anterior inferior spine 
of ilium and anterior intertrochanteric line (spiral line of 
femur), and is known as the "Y" ligament (ilio-femoral). 
This ligament prevents hyperextension of thigh upon pelvis, 
or falling backward of trunk. Capsule is attached to innomin- 
ate bone around margin of acetabulum and to neck of femur ; 
ligamentum teres is attached to head of femur and to bottom 
of acetabulum. Movements permitted: Flexion, extension, 
abduction, adduction, rotation and circumduction. 

Name five muscles of the shoulder and arm. Give the 
origin, insertion and action of any one of the five. 

Deltoid, coraco-brachialis, biceps, triceps, teres major. 
Biceps takes origin by two heads, one from coiracoid process 
of scapula, the other from upper margin of glenoid fossa, this 
tendon passing through shoulder- joint to reach bicipital 
groove ; insertion is into deep fascia of forearm by semilunar 
(bicipital) fascia, and into bicipital tuberosity of radius; 
action is to flex forearm upon arm, and to supinate hand. 

Give the origin, course and branches of any one of the 
following arteries: brachial, temporal, left common carotid. 

Left common carotid arises from arch of aorta, courses 

upward and outward in line drawn from sterno-clavicular 

joint to mastoid, dividing at level of upper border of thyroid 

cartilage into its only branches, external and internal carotids. 

3 



34 ANATOMY. 

Describe the hemispheres and lobes of the brain. 

The cerebral hemispheres are ovoid, convex upon superior 
and lateral surfaces, partially separated from each other by 
longitudinal fissure, but connected by corpus callosum. 
Frontal lobe occupies anterior fossa of cranial cavity, sepa- 
rated from parietal lobe by fissure of Rolando, and from 
anterior part of temporal lobe by Sylvian fissure; parietal 
lobe is bounded by fissure of Rolando anteriorly, parieto- 
occipital fissure posteriorly, Sylvian fissure inferiorly, great 
longitudinal fissure superiorly; occipital lobe is found behind 
parietooccipital fissure ; temporal lobe is below fissure Sylvius, 
and rests in middle cranial fossa. 

Where in the topography of the abdomen is the sigmoid 
flexure located? The appendix vermiformis? 

(a) In left inguinal and hypogastric regions, (b) In right 
inguinal region. 

Give the surgical anatomy of femoral hernia. 

Neck of sac is at femoral, or crural, ring formed by Gim- 
bernat's ligament on inner side, femoral vein on outer, Pou- 
p art's ligament in front, iand horizontal ramus of pubic bone 
behind; is closed by septum crurale; crural canal is narrow 
interval between femoral vein and femoral sheath on inner 
side of vein, and extends from crural ring above to upper 
margin of saphenous opening below. Saphenous opening is 
closed by cribriform fascia. 

Describe the esophagus. 

Extends from lower margin of cricoid cartilage to stomach, 
is ten inches long, situated behind trachea in neck and in 
posterior mediastinum in thorax; curves forward to esopha- 
geal opening in diaphragm, through which it passes, accom- 
panied by pneumogastric nerves; wall consists of external 
longitudinal and internal circular muscle fibres, a submucosa 
and a mucous membrane, which is thrown into longitudinal 
folds, and is made up of stratified epithelial cells. 



ANATOMY. 35 

What is connective tissue? Where in the body is con- 
nective tissue found? 

Connective, or areolar, tissue consists of branched cells, or 
connective tissue corpuscles, the fibres of which interlace and 
form spaces or areolae. It is freely distributed throughout 
the body, forms sheaths of muscles, blood vessels, nerves, etc., 
binds parts together and forms a generally evenly spread-out 
layer beneath the skin, the superficial fascia. 

Into what and how far from the pyloric orifice of the 
stomach does the ductus communis choledochus normally 
open? 

Into the duodenum upon its concave side (descending por- 
tion) three or four inches below the pyloric orifice. 

Give the course, relations and structure of the ureter. 

Begins in the upper expanded portion, the "pelvis of the 
kidney," passes downward behind the peritoneum upon the 
psoas ma gnus muscle, over the brim of the pelvis into pelvic 
cavity, forward to base of bladder, between rectum and blad- 
der in male, y 2 i ncn from cervix in female, then between 
vagina and bladder, terminating at posterior angle of trigone. 
It consists of three coats, fibrous, muscular and mucous. 

What constitutes the brachial plexus? 

The 5th, 6th, 7th and 8th cervical nerves and 1st thoracic 
nerve. 

Mention the ligaments, fissures and lobes of the liver. 

Ligaments are five in number, falciform (suspensory), 
round, coronary, right and left lateral; fissures are five in 
number, fissure for round ligament (obliterated umbilical 
vein), for gall-bladder, for ductus venosus, for inferior cava, 
and transverse fissure; lobes are five in number, right, left, 
quadrate, Spigelian, caudate. 

Mention the abdominal muscles. Describe any one of 
these muscles. 

External and internal oblique, transversalis, recti, pyra- 



36 ANATOMY. 

midales. (Quadratus lumborum, psoas magnus and parvus, 
and iliacus might be included) . Internal oblique takes origin 
from outer half of Poupart's ligament, from anterior two- 
thirds of middle lip of iliac orest, from lumbar aponeurosis, 
from last three ribs; is inserted into linea alba and inner 
extremity of ilio-pectineal line behind Gimbernat's ligament. 
Its aponeurosis divides to form sheath of rectus for its upper 
three- fourths, passing in front of rectus for its lower fourth. 
The line of this division of internal oblique is called linea 
semilunaris ; internal oblique unites with transversalis to form 
conjoined tendon. Action is to flex thorax upon pelvis, or 
vice versa, to rotate trunk toward same side, and to compress 
abdominal viscera. 

Locate the principal groups of lymphatic glands. 

Inguinal (superior and inferior), axillary and cervical 
(superficial and deep). 

Give the anatomy of the true vocal cords. 

Are two in number, formed by crico-thyroid membrane, 
attached to retiring angle of thyroid cartilage anteriorly and 
to vocal process of arytenoid cartilage posteriorly; have 
thy ro- arytenoid muscle along their outer side. They are 
covered by mucous membrane, which is closely attached and 
thin, and consisting of stratified, squamous epithelial cells. 

Give the point of opening of the parotid duct, of the 
submaxillary duct and of the sublingual duct. 

Parotid duct, in cheek wall opposite middle upper molar 
tooth; of submaxillary duct, in fraenum linguae; sublingual 
duct, close to fraenum linguae. 

Describe the ischiorectal fossae and their contents. 

Are located between the lower part of the rectum and the 
ischial tuberosities; are triangular in shape, bounded inter- 
nally by sphincter ani, levator ani and coecygeus muscles; 
externally by tuberosity of ischium; are filled with adipose 
tissue; in outer wall is internal pudic artery; crossing the 
space are inferior hemorrhoidal vessels and nerves. 



ANATOMY. 37 

Give the origin, insertion and action of any one of the 
following muscles: digastric, sacrolumbalis, rectus ab- 
dominis. 

Rectus abdominis takes its origin from body of pubic bone 
and from anterior ligaments of pubic symphysis of opposite 
side, is inserted into costal cartilages of 5th, 6th and 7th ribs ; 
contains three transverse lines (linese transversae) , which 
extend in zigzag style across the muscle in its upper part; 
action is to flex thorax upon pelvis, or vice versa, and to 
compress abdominal viscera. 

Give four principal points of distribution of the pneu= 
mogastric or par vagum nerve. 

Pharynx (motor), larynx (motor and sensory), heart 
(superficial and deep cardiac plexuses), stomach (uniting 
with sympathetic system). 

What is contained in the middle mediastinum? 

Heart and pericardium, ascending aorta, lower part of 
superior cava, vena azygos major, both bronchi, pulmonary 
artery and veins, phrenic nerves. 

What anatomical parts are involved in the descent of 
the testes? 

Gubernaculum testes, visceral and parietal layers of peri- 
toneum, transversalis fascia, inguinal canal and rings, internal 
oblique muscle (cremaster muscle and cremasteric fascia), 
intercolumnar fascia. 

Describe the bones forming the ossa innominata. 

Ilium has curved crest extending from anterior superior to 
posterior spine; internally is iliac fossa (false pelvis, limited 
below by ilio-pectineal line) ; externally are superior, middle 
and inferior gluteal lines; greater sciatic notch is behind, 
partly formed by ischium; anterior inferior spine for rectus 
femoris and ilio-femoral (Y) ligament is below anterior supe- 
rior spine ; ilium forms part of true pelvis and two-fifths of 



38 ANATOMY. 

acetabulum ; fuses with os pubis and ischium at 18th to 20th 
year ; articulates with sacrum by auricular surface. 

Ischium has a body above, with spine of ischium projecting 
backward and inward, and separating greater from lesser 
sciatic notches ; lesser sciatic notch is on ischium below spine ; 
tuberosity of ischium is lowest part, from which ramus as- 
cends toward pubic bone and partially bounds obturator 
foramen; ischium forms two-fifths of acetabulum and part 
of true pelvis. 

Os pubis has body (articulates with opposite bone, forming 
symphysis pubis) ; horizontal and descending ramus, bound- 
ing obturator foramen; pubic spine for Poupart's ligament; 
ilio-pectineal line extending from body along horizontal 
ramus; on under surface of latter is groove for obturator 
vessels and nerve. 

Describe the sternum, its articulations and the import- 
ant muscles attached to it. 

Consists of manubrium, gladiolus and ensiform appendix; 
suprasternal notch is above, between clavicles; notches are 
found along lateral borders for articulation of first seven 
pairs of ribs (costal cartilages), and at upper outer angles 
of manubrium for clavicles; transverse ridge (subcutaneous 
landmark) exists at line of junction of manubrium and gladi- 
olus, marking level of third rib; ensiform varies in size and 
shape. Important muscles attached are sterno-cleido-mastoid 
and pectoralis major; rectus abdominis and diaphragm are 
attached to ensiform. 

What portion of the bladder is uncovered by perito- 
neum? 

The anterior wall, which is separated from symphysis pubis 
by prevesical space (cavum Retzii). 

Describe the spinal cord. 

Is contained in neural canal, and extends from lower mar- 
gin of foramen magnum to body of second lumbar vertebra ; 
constitutes 2 per cent, of cerebro-spinal axis; is surrounded 



ANATOMY. 39 

by dura, arachnoid and pia; has two enlargements, cervical 
and lumbar, which mark points of origin of large nerve trunks 
for upper and lower extremities respectively (brachial and 
sacral plexuses) ; white nerve matter surrounds gray, which 
is arranged like two inverted commas (or capital "H"), 
connected by transverse band (gray commissure) ; anterior 
horn of gray matter contains large multipolar cells continuous 
with motor nerves, which appear upon surface of cord at 
antero-lateral aspect; posterior gray horn is continuous with 
sensory nerves, which appear upon postero-lateral aspect of 
cord. 

Describe the hyoid bone. 

Is U-shaped, placed, with convexity forward, above thyroid 
cartilage; consists of centrally located body, two greater cor- 
nua directed backward and two lesser cornua projecting up- 
ward at point of junction of body and greater cornua. Hyoid 
bone serves for attachment of thyro-hyoid membrane and 
ligament and stylo-hyoid ligament; of sterno-hyoid, thyro- 
hyoid, omo-hyoid, genio-hyoid, genio-hyoglossus, hyogiossus, 
mylo-hyoid, stylo-hyoid and digastric muscles. 

Name the articulations of the superior maxillary bone. 

Frontal, lachrymal, nasal, malar, palate, ethmoid, inferior 
turbinal, vomer and opposite maxilla. 

Give the origin and distribution of the olfactory nerve. 

Olfactory tract appears upon surface of cerebrum at ante- 
rior perforated space, extends forward, terminating in olfac- 
tory bulb, which rests upon cribriform plate of ethmoid ; from 
under surface of bulb 20 to 30 nerves descend, enter superior 
nasal meatus, grooving perpendicular plate and superior and 
middle turbinal processes of ethmoid, and are distributed to 
nasal mucous membrane covering these parts. 

Describe the mammary glands. 

Two hemispherical, lobulated glands placed upon anterior 
thoracic wall over pectoralis major muscle, covering a space 



40 ANATOMY. 

from the second to the sixth rib, and from margin of sternum 
to anterior margin of axilla. Nipple, sensitive and pigmented, 
projects from center, and contains orifices of lactiferous ducts ; 
areola, also pigmented, surrounds nipple; gland substance is 
arranged in lobules (10 to 20), each of which is a compound, 
racemose gland, and all are surrounded and supported by 
fibrous tissue, forming a capsule. 

Describe each of the tunics of the eye and the different 
parts of each. 

Sclerotic is outermost, consisting of bundles of fibrous 
tissue closely interlaced, is perforated to nasal side of pos- 
' terior pole by optic nerve, and is 'continuous with cornea 
anteriorly. Six ocular muscles are inserted into it. Cornea 
is transparent, consists of bundles of fibrous tissue enclosing 
corneal spaces, in which are lodged corneal corpuscles; is 
covered by conjunctival epithelium and lined by Descemet's 
membrane; is richly supplied by sensory nerve fibres, but is 
non-vascular. Uveal tract consists of choroid, ciliary body 
and iris, is vascular and pigmented; choroid is perforated by 
optic nerve behind; ciliary body is made up of ciliary pro- 
cesses and ciliary muscle; iris is placed in front of lens in 
anterior chamber, and is perforated at its center (pupij). 
Retina is innermost tunic, made up of nerve cells and fibres, 
representing an expansion of the optic nerve; macula lutea 
is point of most acute vision, iand is located to temporal side 
of optic disk, or point of entrance of optic nerve; retina is 
supplied by arteria centralis retinae, branch of ophthalmic 
artery, and drained by central vein of retina into ophthalmic 
vein. 

What are the vesiculae seminales? 

Two dilated pouches placed between bladder and rectum, 
uniting with vasa deferentia to form ejaculatory ducts. 

Give the course of the posterior tibial artery. 

Extends from lower border of popliteus muscle down leg 
between superficial and deep layers of muscles to inner side 



ANATOMY. 41 

of ankle, where it divides into internal and external plantar 
branches. 

Which of the cranial nerves has the widest distribution? 

Pneumogastric (10th). 

Describe the origin and distribution of the ninth pair of 
cranial nerves. 

Ninth, or glosso-pharyngeal, nerve has superficial origin 
from groove between olivary and restiform bodies of medulla ; 
is distributed to pharynx (sensory) and to posterior third 
of tongue, especially to circumvallate papillae. 

Give the distribution of the radial nerve below the 
wrist. 

To radial half of dorsum of hand, and dorsum of thumb, 
index, middle and middle-finger half of ring finger, except 
distal segments of digits, which are supplied by median nerve. 

What is the linea alba and how is it formed? 

Is the line of fusion of aponeuroses of external and in- 
ternal oblique and transversalis muscles, extending from en- 
siform above to symphysis below; just below its center is 
umbilicus. 

Describe the sphincter ani. 

Are two in number, internal, or involuntary, and external, 
or voluntary. Internal is formed by circular fibers of rectal 
wall; external is attached to tip of coccyx, surrounds anal 
opening, and is inserted into median line of perineum. 

Describe the periosteum* 

Is closely adherent to outer surface of bone and consists 
of two layers, an outer, fibrous layer, and an inner, vascular 
layer. In young and growing bones the inner is called the 
osteogenetic layer. Nerves and lymphatics are also present 
in periosteum. 

Give the origin, insertion and action of any one of the 



42 ANATOMY. 

following muscles: tibialis anticus, pronator radii teres, 
gracilis. 

Tibialis anticus arises from upper % of outer surface of 
shaft and under surface of outer tuberosity of tibia, from 
interosseous membrane; is inserted into internal cuneiform 
and first metatarsal bones; action, to flex and invert foot; 
to strengthen and help maintain antero-posterior arch of foot. 

Give a general description of the cerebral veins. 

Remarkable for thinness of their walls due to lack of muscu- 
lar tissue ; they have no valves ; superficial cerebral veins are 
lodged in sulci between convolutions, receive blood from sub- 
stance of brain and terminate in the sinuses, opening into 
them in the opposite direction to which blood is flowing ; deep 
cerebral veins drain the ventricles into straight sinus; at 
base basilar vein drains interpeduncular space and basal 
ganglia. 

Relate the differences between a virgin uterus and the 
uterus of a multipara. 

Uterus of multipara is larger (especially body) , arbor vitse 
uteringe of cervix is more or less effaced, external os is 
irregular, or perhaps stellate, instead of being a smoothly 
outlined, transversely directed slit. 

Describe a hair follicle in its relations to the skin. 

A hair follicle is an involution of epidermis, forming a 
funnel-shaped depression sometimes extending into subcu- 
taneous cellular tissue; is usually placed obliquely and be- 
comes enlarged at bottom to accommodate hair bulb, part of 
which is vascular papilla derived from dermal lining of 
follicle; opening into follicle are ducts of one or more se- 
baceous glands. 

What are the Wormian bones? 

Bones developed from separate centers of ossification to 
fill in gaps between certain of the cranial bones; they are 
found most frequently in lambdoid suture, occasionally oc- 
cupying position of fontanelles, especially posterior. 



ANATOMY. 43 

Name the humors of the eyeball. 

Aqueous humor, contained in anterior chamber, consists of 
98.6% water, and small quantities of extractives and pro- 
teids ; vitreous humor, occupying the large posterior chamber, 
has about the same composition as aqueous humor. 

State the origin of the sensory division of the fifth pair 
of cranial nerves. 

Superficial origin is from under surface of pons, close to 
anterior border. 

What is the function of the third cranial nerve? 

To supply with motor influence all ocular muscles except 
superior oblique and external rectus, and to furnish motor 
root to ophthalmic ganglion. 

Describe the ramus of the jaw. Mention the muscles 
and ligaments attached to the ramus of the jaw. 

Ramus extends upward and slightly backward, forming 
angle of jaw by its junction with the body; is surmounted 
by coronoid process anteriorly and condyle posteriorly, be- 
tween which is sigmoid notch; upon inner surface is inferior 
dental foramen. 

Muscles and ligaments attached are : Temporal, external and 
internal pterygoids, masseter; capsular and internal lateral 
ligament of temporo-mandibular articulation, stylo-mandibu- 
lar ligament. 

Describe the arytenoid cartilages. 

Are pyramidal in shape, rest upon upper, posterior part of 
cricoid cartilage by their bases, have true vocal cord (thyro- 
aretynoid ligaments) attached to vocal process anteriorly; 
lateral crico-arytenoid, posterior crico-arytenoid, arytenoid 
and thyro-arytenoid muscles are also attached. The arytenoid 
cartilages are covered with mucous membrane and between 
them is the inter arytenoid space. 



44 ANATOMY. 

Give the course and relations of the external jugular 
vein. 

Is formed near angle of jaw by union of temporo-maxillary 
and posterior auricular veins, runs downward and outward 
upon sternomastoid muscle and under platysma myoides, to 
empty into subclavian vein at middle of clavicle. 

Mention the branches of the internal iliac artery. 

Anterior trunk: Superior, middle and inferior vesical, ob- 
turator, middle hemorrhoidal, uterine, vaginal, internal pudic 
and sciatic. From posterior trunk: Ilio-lumbar, gluteal, 
lateral sacral. 

Give the course of the female ureters. 

Rest upon psoas magnus muscles, pass over brim of pelvis 
into cavity of same to base of broad ligaments, then 
y 2 inch from cervix uteri, laterally, obliquely forward and 
inward in anterior vaginal wall to base of bladder. 

What nerves form the pharyngeal plexus? 

Glosso-pharyngeal, pneumogastric and cervical sympathetic. 
What structures are severed in tracheotomy? 

Skin, superficial and deep cervical fascia and trachea ; per- 
haps anterior jugular vein, or branches, and thyroid isthmus. 

Describe the phrenic nerve. 

Is formed by the fourth cervical nerve, chiefly, passes down- 
ward upon anterior surface of scalenus anticus muscle, enters 
superior, then middle mediastinum and perforates diaphragm 
to supply its under surface. 

Describe the ulnar artery as to (a) origin, (b) course, 
(c) distribution. 

(a) Is one of terminal branches of brachial; (b) is beneath 
superficial flexors of forearm, passes obliquely to ulnar border, 
having ulnar nerve to ulnar side of it for lower % of its 
extent, then curves across palm near lower border of anterior 
annular ligament (superficial palmar arch), first sending 



ANATOMY. 45 

communicating branch to deep arch, (c) Is distributed to 
structures around internal aspect of elbow, to ulnar side of 
forearm, to interosseous membrane, anteriorly 'and posteriorly, 
and adjacent muscles, and to palm and flexor surface of 
fingers. 

How are the saphenous veins formed? Where do the 
saphenous veins empty? 

Internal saphenous is formed upon dorsal surface of foot 
and inner border ; external saphenous is formed upon dorsum 
and outer border of foot. Internal saphenous vein empties 
into femoral at saphenous opening in fascia lata; external 
saphenous terminates in popliteal vein. 

Give the situation of the lymphatic glands of the thorax. 

Intercostal spaces posteriorly, anterior and posterior medi- 
astina, around bronchial tubes. 

Give the boundaries and mention the contents of the 
posterior mediastinum. 

Is bounded in front by pericardium and roots of lungs, 
behind by vertebral column and on either side by pleura. It 
contains descending thoracic aorta, greater and lesser azygos 
veins, pneumogastric and splanchnic nerves, esophagus, thor- 
acic duct and lymphatic glands. 

Describe the internal abdominal ring. 

Is oval in shape, long axis directed vertically, located in 
transversalis fascia % inch above Poupart's ligament and 
midway between anterior superior iliac and pubic spines. 
Structures of spermatic cord pass through it in male, round 
ligament in female. Infundibuliform fascia is attached to 
its margin ; deep epigastric artery courses along inner margin. 

Give a method by which the fissures of Sylvius and 
Rolando may be approximately mapped out on the sur- 
face of the skull. 

Fissure of Sylvius : Draw a line from a point one inch and 
a quarter horizontally behind external angular process of 



16 ANATOMY. 

frontal bone to a point % of an inch below parietal eminence. 
Fissure of Rolando: From a point y 2 inch behind mid-point 
of line between glabella and external occipital protuberance, 
draw a line for 3% inches over side of head at angle of 67° 
with median line. 

Locate and describe Peyer's glands. 

Are located in wall of ilium, more numerous at lower 
part; are more or less oval bodies collected together; con- 
sist of adenoid (lymphoid) tissue. 

Describe the tonsils and name some of the arteries 
which supply them with blood. 

Are placed between anterior and posterior palatine arches, 
in tonsillar recess, close to base of tongue, vary greatly in 
size and shape, surface is irregular and marked by numerous 
depressions leading into crypts in substance of tonsil, and are 
surrounded by closed follicles of lymphoid tissue. Arteries: 
Dorsalis linguae, ascending palatine and tonsillar of facial, 
descending palatine of internal maxillary, ascending pharyn- 
geal. 

Describe the male urethra and state its divisions. 

Divided into prostatic, membranous and spongy portions; 
prostatic passes through prostate gland, has vera montanum 
and orifices of ejaculatory ducts in its floor, upon either 
side of which are prostatic sinuses with orifices of prostatic 
glands; membranous portion is shortest of the three, is con- 
tained between the two layers of triangular ligament, and 
surrounded by compressor urethrae muscle ; spongy portion is 
contained in corpus spongiosum, terminates at meatus urin- 
arius externus (least dilatable part of urethra) and has 
several depressions in mucous membrane of roof, largest 
of which, just behind fossa navicularis, which is close to 
meatus, is named lacuna magna. 

What is the origin and course of the pulmonary artery? 

Origin is from right ventricle; course is upward and 



ANATOMY. 47 

slightly to left to under surface of transverse portion of 
aortic arch, where it divides into right and left pulmonary 
arteries for right and left lungs respectively. 

Give the names of the principal muscles of the back. 

Trapezius, latissimus dorsi, rhomboideus major and minor, 
erector spinas. 

Locate and describe the rectum. 

Extends from third piece of sacrum to anus, with forward 
curve, is covered by peritoneum in front and on the sides 
only; longitudinal and circular muscular fibers pronounced; 
mucous membrane thick, presenting several permanent, trans- 
verse folds, plica? recti, or valves of Houston ; is supplied by 
superior, middle and inferior hemorrhoidal arteries; is be- 
hind bladder and prostate in male and vagina in female. 

Where does the abdominal aorta commence and where 
does it terminate? 

Commences at aortic opening in diaphragm upon body of 
twelfth thoracic vertebra; terminates upon body of fourth 
lumbar vertebra, just to left of median line. 

Where is the foramen ovale of the heart and what 
purpose does it serve? 

In the wall between the auricles; permits passage of blood 
in the foetus from right to left auricle, deflecting its course 
from right ventricle and pulmonary circulation into general 
circulation. 

What are the lymphatic glands? 

Parts of lymphatic system consisting of adenoid tissue, 
enclosed in capsule, having afferent and efferent lymphatic 
vessels ; lymph passes through them. 

Describe the changes in the vascular system at birth. 

Blood ceases to flow through umbilical vein and ductus 
venosus into inferior cava; hypogastric arteries become ob- 
literated; foramen ovale closes and blood then does not pass 






48 ANATOMY. 

from right to left auricle; ductus arteriosus, connecting pul- 
monary artery with arch of aorta becomes impervious and 
pulmonary circulation is actively established. 

In the anatomy of the brain what is the corpus callo- 
sum? Describe its connections. 

The great transverse commissure consisting of fibers which 
pass from one hemisphere to the other, connecting different 
parts of the cortex of one with that of the other, is located 
nearer the base than the top and forms the roof of the lateral 
ventricles. 

Mention a muscle (a) which moves the thumb outward, 
(b) which moves the head forward, (c) which moves the 
foot inward. 

(a) Abductor pollicis; (b) sterno-cleido-mastoid (rectus 
capitis anticus major) ; (c) tibialis anticus. 

What is the composition of intervertebral substance? 
How much of the spinal column does this substance form? 

Is made up of fibre- cartilage ; constitutes about V± of the 
spinal column. 

Give the boundaries of the anterior mediastinum. 

In front by the sternum, behind by the pericardium, later- 
ally by the pleurae. 

What are the ciliary processes in the eye? Where are 
they placed and what is their average number? 

Folds of middle tunic (uveal tract) consisting of con- 
nective tissue, blood vessels and pigment; are placed around 
periphery of lens close to edge, posteriorly, and number about 
seventy. 

State the action of each of the following muscles: mas- 
seter, tibialis anticus, gluteus maximus. 

Masseter, to bring lower jaw up against upper jaw ; tibialis 
anticus, to flex foot upon leg and elevate and adduct inner 
border of foot ; gluteus maximus, to extend trunk upon thigh, 
or thigh upon trunk. 



ANATOMY. 49 

Give a general description of the peritoneum. Name 
the principal organs covered by it. 

Is a closed sac (except in female, at orifices of Fallopian 
tubes) which lines abdominal wall (parietal layer) and 
partially or completely surrounds viscera (visceral layer), 
constituting their serous coat; it forms omenta: Gastro-colic, 
or great omentum, gastro-hepatic, or lesser omentum, and 
gastro-splenic ; it forms mesenteries: Mesentery (proper), of 
small intestine, mesocolon (ascending, transverse, descending, 
sigmoid, mesoappendix) ; principal organs covered by peri- 
toneum are: Liver, stomach, spleen, small intestine, large 
intestine, Fallopian tubes, uterus, bladder. 

Describe the thymus gland. 

Is first found during second month of intrauterine life, 
is largest when child is two or three years old, and usually 
disappears before puberty ; is located in anterior mediastinum 
and lower part of neck, between lungs, in front of heart 
and great vessels and trachea; consists Of two lobes made up 
of lobules, which are essentially lymphatic in character. 

What are the suprarenal capsules and what are their 
relations to adjacent organs and parts? 

Are two in number, one placed upon the upper pole of 
each kidney ; each consists of cortex and medulla with vessels 
entering and leaving at a hilum ; cortex is yellowish in color 
and contains granular, polyhedral cells arranged in columns ; 
medulla is darker in color, from presence of bloodvessels 
which are closely related to groups of large cells. Suprarenal 
bodies are partially covered by peritoneum and are in rela- 
tion, right with under surface of liver, left with spleen, 
stomach and pancreas. 

Describe the medulla oblongata. 

Is a part, of encephalon, continuous with spinal cord be- 
low and with pons above; it rests upon basilar process of 
occipital bone, consists of white nerve matter externally 
and gray matter arranged irregularly internally, the latter 
4 



50 ANATOMY. 

appearing upon the surface in floor of fourth ventricle, the 
lower half of which is formed by upper surface of medulla^ 
upon ventral surface is anterior median fissure, partially 
obliterated below by decussation of crossed pyramidal tracts; 
near anterior part of inferior surface are olivary bodies; 
posterior columns diverge to form calamus scriptorius and to 
bound fourth ventricle laterally for its lower half; postero- 
laterally are restiform bodies which can be traced upward 
into cerebellum, forming inferior peduncles of latter. 
Cranial nerves from seventh to eleventh inclusive arise from 
side of medulla, while twelfth appears upon surface in groove 
between olivary body and anterior pyramid. 

Locate and describe the lachrymal gland. 

Is located in upper, outer and -anterior part of orbit, to 
inner side of external angular process ; is made up of lobules, 
or clusters of acini, arranged around the ducts, six to twelve 
in number, which empty into outer part of superior con- 
junctival fornix. 

Describe the lungs. 

Each is pyramidal in shape, base resting upon diaphragm, 
apex extending into superior aperture of thorax, lateral, con- 
vex surface being applied to thoracic wall and inner, mesial 
and irregularly concave surface looking toward mediastinum ; 
each possesses a root, placed upon inner surface, near pos- 
terior, thickened margin, and consisting of bronchus, pulmon- 
ary artery and vein, bronchial artery, nerves and lymphatics ; 
right lung has three lobes, left has two; each is made up of 
lobules consisting of a terminal bronchiole, around which are 
arranged clusters of air cells ; each lung is invested by visceral 
layer of pleura, whose parietal layer lines thoracic wall. 

Describe the structure of the knee-joint. 

Bones: Femur, tibia, patella; ligaments: Internal and ex- 
ternal lateral, ligamentum patella?, posterior; these are 
strengthened and supported by aponeuroses of vastus externus 
and internal antero-laterally, semimembranosus posteriorly; 



ANATOMY. 51 

chief internal ligaments are crucial, anterior and posterior; 
joint contains two semilunar cartilages which are attached to 
non-articular area upon upper surface of tibia ; synovial mem- 
brane is extensive and complicated ; movements : Flexion, ex- 
tension, slight rotation. 

Bound the popliteal space. Mention its contents. 

Above by outer and inner hamstrings, below by outer and 
inner heads of gastrocnemius muscle, with plantaris upon 
outer side; contents are: Internal and external popliteal 
nerves, popliteal vein and popliteal artery, termination of 
short saphenous vein and small lymphatic glands. 

Mention* the principal branches of the coeliac axis. 

Gastric, hepatic and splenic arteries. 

What are the nerves of the eyeball? 

Optic, motor oculi and ophthalmic division of fifth (both 
through ophthalmic ganglion) and sympathetic fibers from 
cavernous plexus (also to ganglion). 

Describe the aural labyrinth. 

Osseous labyrinth, whose divisions are three semicircular 
canals posteriorly placed, a vestibule in middle, and cochlea 
anteriorly, all containing membranous labyrinth upon which 
terminal filaments of auditory nerve and i,ts special neuro- 
epithelium are found. 

Describe the popliteal artery and give its branches. 

Is a continuation downward of femoral from opening in ad- 
ductor magnus and divides at lower border of popliteus 
muscle into anterior and posterior tibial arteries; it lies upon 
femur, posterior ligament of knee-joint, tibia, and fascia cov- 
ering popliteus muscle; it enters popliteal space at upper 
inner margin, and bisects it longitudinally; popliteal vein 
is superficial to it ; branches are superior and inferior internal 
and external articular, azygos articular, sural (muscular to 
calf), and anterior and posterior tibial. 



52 ANATOMY. 

What are the bIood=vessels which supply the arteries 
called? Whence are the nerves of the arteries derived? 

(a) Vasa vasorum. (b) Vasomotor, from sympathetic 
system. 

Mention the varieties of epithelium. 

Squamous, columnar, ciliated, glandular, transitional, pig- 
mented, and neuro-epithelium. The first three may occur in 
a single layer, when it is named "simple;" or, in several lay- 
ers, when it is called "stratified." 

Describe the muscular tissue. 

Muscular tissue is of mesodermic origin and consists prin- 
cipally of elongated cells (fibrous cells) which have the in- 
herent power of contracting. The muscle fibers contain 
nuclei and, sometimes, that which corresponds to a cell wall, 
the sarcolemma. Voluntary and cardiac muscles are striated, 
due to the arrangement of alternate light and dark discs. 
Non-striated muscle is involuntary. Microscopically, they 
may be differentiated as follows: 

Striated. Non=Striated. Cardiac. 

Fibers striated trans- No striations. Striated longitudinally 

versely. and transversely. 

Has sarcolemma. Hyaline sheath. No sarcolemma. 

Nucleus beneath sarco- Nucleus in center. Nucleus oval and in 

lemma. center. 

Fibers do not branch, Fibers short. 

except in the tongue. Fibers branch freely. 

Describe a Haversian system. 

A Haversian system occurs in compact bone and consists 
of a system of channels through which the nutrient fluids 
pass. It consists of the following : A centrally placed canal, 
the Haversian canal, which is surrounded by concentric lay- 
ers or plates of bone, the lamella. Between the plates of 
bone are irregular clefts, the lacunae, which communicate with 
each other and with the Haversian canal by means of radially 
placed canals — the canaliculi. 



ANATOMY. 53 

Describe the formation of the teeth. 

The teeth are composed of three substances — the enamel, 
the dentine and the cementum. The enamel covers the ex- 
posed part of the tooth, the crown of the tooth. The ce- 
mentum covers the part of the tooth within the alveolus of 
the jaw. The junction of the enamel with the cementum 
is called the neck of the tooth. The bulk of the tooth is 
made up of the dentine, which extends from the root to the 
crown. Each tooth contains a cavity, the pulp cavity, which 
communicates with the exterior through a small aperture at 
the apex of the root, the apical foramen. The cavity con- 
tains a soft connective tissue — the pulp, rich in vessels and 
nerves. The fang, or root of the tooth has a fibrous invest- 
ment called the peridental membrane, or periosteum. 

Give a brief description of the facial nerve. 

The 7th cranial nerve, after passing through facial canal 
(aqueductus Fallopii) of temporal bone, emerges at the stylo- 
mastoid foramen, and enters substance of parotid gland. 
Here it divides into 2 sets of branches, temporo-facial and 
cervico-facial, supplying muscles of expression. Its chorda 
tympani branch traverses inner surface of membrana tym- 
pani, after leaving main trunk in facial canal, and emerg- 
ing through one end of the Grasserian fissure unites with lin- 
gual branch of 5th and accompanies it to submaxillary gland 
and ganglion and anterior % of mucous membrane of tongue. 

Describe the e!bow=joint. 

Is a ginglymus, or hinge- joint, made up of lower end of 
humerus and upper ends of radius and ulna; head of radius 
articulates with capitellum, and greater sigmoid cavity of 
ulna with trochlear surface of humerus. Its capsule is 
divided into anterior and posterior, internal and external 
lateral ligaments. It permits of flexion and extension. It 
is lubricated by synovial membrane lining its capsule. 

Describe the superior vena cava. 

Is formed by union of right and left innominate (jugulo- 



54 ANATOMY. 

cephalic) veins, just below cartilage of 1st rib (close to right 
border of sternum) ; is nearly three inches long and terminates 
in right auricle ; it receives vena azygos major. 

Describe the temporo=maxiIlary articulation, mentioning 
the ligaments. 

Bony parts are glenoid fossa and articulating eminence of 
temporal bone, and condyle of mandible; ligaments form a 
capsule, much stronger externally and posteriorly; external 
lateral ligament extends between tubercle of zygoma and 
neck of condyle; associated ligamentous bands are spheno- 
mandibular and stylo-mandibular ; an interarticular cartilage 
contained within the joint cavity has tendon of insertion of 
external pterygoid muscle attached to it. Movements per- 
mitted are depression and elevation of jaw around a trans- 
verse axis, and a sliding forward of both sides, protruding 
chin, or of one side at a time, producing a triturating 
movement. 

Describe the maxillary sinus (or antrum of Highmore). 

Is a triangular cavity contained in body of maxilla, lined 
with mucous membrane and communicating with middle 
meatus of nose through one or two small openings; apex of 
cavity is formed by malar process of maxilla; base is formed 
by outer wall of nose; in its posterior wall are posterior 
dental canals for posterior dental vessels and nerves to the 
teeth ; in floor are usually seen several elevations, correspond- 
ing to roots of 1st and 2d molar teeth. 

Describe the aorta. 

Springs from left ventricle, anteriorly, extends upward 
to upper border of right 2d costal cartilage, then arches 
backward to left and descends through thorax, resting upon 
vertebral bodies, passes through aortic opening in diaphragm 
and courses through abdominal cavity as far as body of 4th 
lumbar vertebra. 

Branches are: Two coronary from ascending portion; in- 
nominate, left common .carotid and left subclavian from arch ; 



ANATOMY. 55 

bronchial, intercostal, pericardiac, esophageal and posterior 
mediastinal from thoracic portion; 2 phrenic, lumbar, sacra 
media (parietal branches), celiac axis (gastric, hepatic, 
splenic), superior mesenteric, inferior mesenteric (single 
branches from front), suprarenal, renal, spermatic (or 
ovarian) (lateral paired branches) from abdominal portion. 

Describe the trachea and give its anatomical relations. 

It extends from the larynx to the bronchi, and consists of 
a series of transversely directed, incomplete rings of cartilage 
united by an elastic membrane which contains involuntary 
muscle-fiber posteriorly, where the cartilaginous ring is de- 
ficient; it is lined with, a mucous membrane which is covered 
with ciliated columnar epithelial cells. 

The trachea rests upon the esophagus, being flattened pos- 
teriorly; in the groove between these two structures is the 
recurrent laryngeal nerve, upon each side; the common caro- 
tid artery, internal jugular vein and pneumogastric nerve 
are close to it at its lower portion, while the isthmus of the 
thyroid body crosses it upon its second and third rings, and 
the lobes of the same rest upon it laterally. 

Describe the pulmonary veins. 

They are four in number, usually, 2 for each lung, and 
return arterial blood from lungs to left auricle of heart. 

Describe the spinal column. 

It consists of 33 separate vertebras, distributed as follows: 
7 cervical, 12 thoracic, 5 lumbar, 5 sacral, 4 coccygeal. Sacral 
and coccygeal coalesce early in life by ossification of inter- 
vertebral substances; cervical segment possesses curve with 
convexity forward, thoracic with convexity backward, lum- 
bar with convexity forward, sacral with convexity backward ; 
line of gravity passes through chords of these curves. 
Special or peculiar vertebrae are : Atlas, axis, 7th cervical 
(vertebra prominens) ; ribs articulate with thoracic series; 
ilia articulate with sacrum. Spinal column contains neural 
canal for spinal cord. 



56 ANATOMY. 

Give the minute anatomy of the skin. 

The skin consists of the cutis vera, formed of fibrous tissue, 
the superficial layer being raised into numerous papillae. 
This is the vascular layer of the skin. The end bulbs of the 
sensory nerves are found here also. Covering the cutis vera 
is the epidermis, formed of numerous layers of epithelium. 
There are four strata of the epithelium : The outer, horny, or 
stratum corneum; the stratum lucidum; the stratum granu- 
losum, and the inner or stratum mucosum. 

Give a general description of the alimentary canal, nam- 
ing its successive divisions. 

Its parts, in order, are: Mouth, pharynx, esophagus, 
stomach, small intestine (duodenum, jejuno-ileum) , large in- 
testine (cecum, ascending, transverse, descending and sigmoid 
colons, rectum and anal canal) . 

Mouth is composed of upper and lower jaws covered by 
cheek walls, with buccal orifice directed transversely; con- 
tains tongue, at base of which are fauces with anterior and 
posterior pillars and tonsils. 

Pharynx joins esophagus at lower border of cricoid carti- 
lage; esophagus is 10 inches long and passes through dia- 
phragm to be continued into stomach. 

Stomach occupies epigastric and left hypochondriac regions 
and presents a cardiac and a pyloric extremity and a greater 
and lesser curvature. Its wall consists of 4 coats, viz., serous, 
muscular, areolar and mucous. 

Duodenum is fixed and curved around head of pancreas; 
common bile and pancreatic ducts open into it; jejuno-ileum, 
attached to posterior abdominal Avail by mesentery, extends 
for 20 feet, or more, to ileo-cecal junction, where it joins large 
intestine; vermiform appendix is attached to cecum (usually 
inner side), below ileo-cecal valve; ascending colon passes to 
liver, forms hepatic flexure; transverse colon, with great 
omentum attached, crosses to spleen and forms splenic flexure ; 
descending colon reaches left iliac fossa and is continued into 
sigmoid which curves around into pelvis, resting on sacrum; 



ANATOMY. 57 

rectum curves forward and anal canal, guarded by internal 
(involuntary) and external (voluntary) sphincters, opens 
downward and slightly backward. 

State the origin and exit of the pneumogastric nerve. 

Superficial origin, from side of medulla in groove between 
olivary and restiform bodies; exit, through jugular foramen. 

Describe the mastoid portion of the temporal bone. 

Mastoid bone is placed behind, is rough and convex exter- 
nally and projects downward and forward as mastoid process; 
beneath are digastric fossa for posterior belly of digastric 
muscle, and occipital groove for occipital artery; within sub- 
stance of mastoid are mastoid cells, the largest of which 
is called mastoid antrum, which communicates with middle 
ear; upon cerebral surface of mastoid is sigmoid groove for 
lateral sinus. 

Describe the lateral sinuses. 

Right and left lateral sinuses commence at internal occi- 
pital protuberance, right being formed by superior longitu- 
dinal sinus, left by straight sinus; are located in attached 
margin of tentorium, grooving occipital, parietal, mastoid and 
occipital bone again, leaving cranial cavity through jugular 
foramen, just outside of which they unite with inferior pe- 
trosal sinus to form internal jugular vein. 

Give the origin and insertion of the muscles which form 
the anterior triangles of the neck. 

The anterior common triangle is bounded above by the 
lower border of the mandible and a line extending backward 
from the angle of the mandible to the mastoid process of the 
temporal bone; in front, by the median line of the neck; 
behind, by the anterior border of the sterno-mastoid muscle. 
This common triangle is divided into the submaxillary, su- 
perior carotid and inferior carotid triangles, by the posterior 
belly of the digastric muscle above and the anterior belly of 
the omo-hyoid below. 

Sterno-mastoid muscle : Origin, from anterior surface of up- 



58 ANATOMY. 

per part of manubrium sterni and inner third of anterior 
border of clavicle ; insertion, into mastoid process of temporal 
and outer half of superior curved line of occipital bone. 

Omo-hyoid muscle: Origin, from upper border of scapula 
to inner side of suprascapular notch; insertion, into body 
of hyoid bone. 

Digastric muscle : Origin of posterior belly is from digastric 
fossa of mastoid portion of temporal bone, and of anterior 
belly from lower border of mandible close to symphysis; in- 
sertion, into central tendon, which is attached to body and 
greater cornu of hyoid bone. 

Name and describe the course of the arteries supplying 
the hand. 

Radial and ulnar arteries. Course of radial artery is from 
just below bend of elbow down radial border of forearm to 
outer side of wrist, where it turns over on to dorsum of hand, 
passes down through proximal end of first interosseous space 
to reach palm, now passing transversely across deep part of 
palm to anastomose with deep communicating branch of 
ulnar artery. 

Course of ulnar artery is from near head of radius in a 
curve over to ulnar border of forearm, thence along ulnar 
border to radial side of pisiform bone, where it divides into a 
superficial branch, to form superficial palmar arch and a deep 
branch to complete deep arch. 

Locate and describe the ovaries. 

The ovaries are located ordinarily close to lateral part of 
true pelvic brim, attached to posterior layer of broad ligament. 
They somewhat resemble a broad almond, are iy 2 inches in 
length, whitish in color, with an uneven, puckered surface, 
and consist of a covering of germinal epithelium, and a stroma 
which encloses ovisacs, vessels and nerves. 

Locate and describe the principal convolutions of the 
brain. 

Ascending frontal convolution bounds the fissure of Rolando 



ANATOMY. 59 

anteriorly, and belongs to the frontal lobe; ascending parietal 
convolution bounds the fissure of Rolando posteriorly, and is 
a part of the parietal lobe. In these convolutions are located 
important motor nerve-centers, controlling nerves which are 
distributed to the opposite side of the body. 

The cuneus is a convolution belonging to the mesial surface 
of the occipital lobe, between the internal parietooccipital 
and calcarine fissures; in it are located the cortical centers 
of sight. 

Describe the palmar fascia. 

It consists of a central and two lateral portions. Central 
portion is thick and binds down tendons and protects vessels 
and nerves; it is narrow above where it is attached to an- 
terior annular ligament; below it is broad and divides into 4 
slips for the four fingers, these being attached to under 
surface of skin at base of fingers, to sides of metacarpo-phalan- 
geal joints and to sides of metacarpal bones near their distal 
ends. 

Give the origin and insertion of the muscles of the 
scapulohumeral joint. 

Supraspinatus, infraspinatus, teres minor, subscapularis, 
deltoid, biceps and triceps. 

Supraspinatus : Origin, from inner % of supraspinous fossa ; 
insertion, into highest facet of greater tuberosity of humerus, 
and blending intimately with capsular ligament of shoulder 
joint. 

Infraspinatus : Origin, from inner % of inf raspinous fossa ; 
insertion, into middle facet of greater tuberosity, also blend- 
ing with capsular ligament. 

Teres minor : Origin, from upper % of axillary border of 
scapula; insertion, into lowest facet of greater tuberosity, 
also blending with capsular ligament. 

Subscapularis: Origin, from greater part of subscapular 
fossa; insertion, into lesser tuberosity of humerus, its tendon 
of insertion also blending closely with capsular ligament. 



60 ANATOMY. 

Deltoid : Origin, from outer V3 of anterior border of clavicle, 
from outer margin of acromion and lower border of spine of 
scapula; insertion, into rough, triangular area on outer side 
of shaft of humerus near its middle. 

Biceps : Origin, from coracoid process and from upper mar- 
gin of glenoid cavity (short and long heads, respectively) ; 
insertion, into bicipital tuberosity of radius and by bicipital 
(or semilunar) fascia, into deep fascia of forearm. 

Triceps: Origin, from axillary border of scapula just be- 
low glenoid cavity (long, or scapular head), and from pos- 
terior surface of humerus, one head above, the other below, 
the musculo-spiral groove (2 short or humeral heads) ; inser- 
tion, into olecranon process of ulna. 

Describe the nasal fossae. 

Are 2 irregular cavities in middle of face, on either side 
of median line, separated from each other by mesially placed 
nasal septum ; they extend upward to anterior floor of cranial 
cavity, and downward to roof of mouth ; they open anteriorly 
by 2 large apertures, the anterior nares, and communicate 
with naso-pharynx by posterior nares. 

Roof is narrow, and formed in center by cribriform plate 
of ethmoid, anteriorly by nasal bones and nasal spine of 
frontal, posteriorly by under surface of body of sphenoid. 
Roof contains apertures in cribriform plate for olfactory 
nerves; behind are openings leading into sphenoidal sinuses. 

Floor is smooth, wider in middle than at either end, and 
is formed by palate process of maxilla, anteriorly, and by 
palate process of palate bone posteriorly. 

Inner wall consists of septum, which is made up of crest 
of nasal bones and spine of frontal, by perpendicular plate 
of ethmoid, by vomer and by rostrum of sphenoid, and below 
by crests of maxillary and palate bones. A large notch at an- 
terior extremity of bony septum receives the septal cartilage. 

Outer wall is formed, in front, by lachrymal bone and nasal 
process of maxilla; in the middle, by ethmoid, inner surface 
of maxilla, and inferior turbinated; behind, by vertical plate 



ANATOMY. 61 

of palate bone and internal pterygoid plate of sphenoid. The 
-•outer wall contains 3 irregular, longitudinal passages, viz., 
superior, middle and inferior meati ; the superior meatus 
(smallest) is located at upper and back part of nasal fossa, 
is between superior and middle turbinated bones, and com- 
municates with spheno-maxillary fossa by spheno-palatine 
foramen, and with posterior ethmoidal cells by an opening 
in its outer wall. (Opening for sphenoidal sinus is above and 
behind superior turbinated bone). Middle meatus is situ- 
ated between middle and inferior turbinated bones. It con- 
tains, anteriorly, the orifice of the infundibulum, by which 
the middle meatus is placed in communication with the an- 
terior ethmoidal cells and the frontal sinuses; the middle 
ethmoidal cells and maxillary antrum also open into middle 
meatus. Inferior meatus is the largest, is formed by inferior 
turbinated above and floor of nasal fossa below; it contains, 
under cover of the inferior turbinated, anteriorly, the termin- 
ation of the naso-lachrymal duct. 

Name and locate the accessory sinuses of the face and 
describe their outlets. 

Frontal sinuses, contained between outer and inner tables 
of frontal bone above supraorbital arch, communicate through 
infundibulum with anterior ethmoidal cells and middle nasal 
meatus. 

Ethmoidal cells, comprising greater part of lateral mass 
of ethmoid bone, and divided into anterior, middle and pos- 
terior. Anterior and middle ethmoidal cells open into middle 
nasal meatus; posterior ethmoidal cells open into superior 
nasal meatus. 

Sphenoidal cells (or sinuses) are contained within body of 
sphenoid bone and communicate with upper, back part of 
nasal fossa. 

Maxillary sinus (antrum of Highmore) is situated in body 
of maxilla; its outlet is an aperture communicating with 
middle meatus of nose. 



62 ANATOMY. 

Describe the iris, giving relations, nerve and blood 
supply. 

It is an elastic, contractile diaphragm, forming the anterior 
extremity of the middle, pigmented and vascular tunic of the 
eyeball. By its peripheral attached border it is directly 
continuous with the ciliary body; it is placed in front of the 
crystalline lens, and incompletely divides the anterior cham- 
ber into two compartments. Near its center is a circular 
opening, the pupil, which varies greatly in size. In structure 
the iris consists of a stroma of delicate fibrous and elastic 
tissue, with perhaps some involuntary muscle fibers. It is 
supplied by the ciliary nerves. The long and anterior ciliary 
arteries anastomose and form a vascular circle around the 
attached margin of the iris, sending branches in toward the 
pupillary margin. 

Describe the course and distribution of the nerves of 
the palm of the hand. 

Median, from outer and inner cords of brachial plexus, ac- 
companies brachial artery, rests upon flexor profundus digi- 
torum in forearm, passes beneath annular ligament into palm. 
It supplies all anterior forearm muscles except flexor carpi 
ulnaris and ulnar half of flexor profundus digitorum; cuta- 
neous branches supply palm, thumb, index, middle and half 
of ring fingers on their palmar aspect and nail-beds, and outer 
two lumbricales. 

Ulnar, from inner cord, descends along inner border of 
arm, behind inner condyle of humerus, then between flexor 
carpi ulnaris and flexor profundus, both of which it supplies ; 
it crosses anterior annular ligament with ulnar artery and 
divides to supply short muscles of little finger, all interossei, 
inner two lumbricales and flexor brevis and adductor pollicis ; 
cutaneous distribution is to dorsum and palm of hand on 
ulnar side, and to little finger and ulnar half of ring finger. 

If the femoral artery were obstructed at the apex of 



ANATOMY. 63 

Scarpa's triangle, through what channels would the blood 
flow to reach the tibial artery? 

Through profunda femoris and its branches, anastomosing 
with articular branches of popliteal. 

Name the structures that maintain the bladder in posi= 
tion, male and female. 

Recto- vesical fascia, folds of peritoneum, in both sexes; 
rectum in male, uterus and vagina in female. 

Where are the ventricles of the larynx? 

Between the true and false vocal cords. 

Describe the triangle of the elbow and name the struc= 
tures that pass through it. 

Base directed upward, formed by line drawn between the 
two condyles, outer side bounded by supinator longus, inner 
side by pronator radii teres; floor is formed by brachialis 
anticus and supinator brevis. It contains brachial artery 
and venas comites, radial and ulnar arteries, median and 
musculo-spiral nerves, and tendon of biceps. 

Name the abdominal viscera partially covered by peri= 
toneum. 

Right and left suprarenal bodies, right and left kidneys, 
pancreas, duodenum, ascending and descending colons, rec- 
tum, bladder, uterus. 

Describe the arteries and veins passing to and from the 
kidneys. 

Renal artery, branch of abdominal aorta, enters hilum r 
breaks up into branches which pass between Malpighian pyra- 
mids to cortico-medullary junction, then sending branches 
into cortex and medulla. Veins are similarly arranged, be- 
ginning in interior of kidney ; they leave by passing through 
sinus and hilum, known as renal vein, to join inferior cava. 



64 ANATOMY. 

Give the anatomy of the bladder, including blood and 
nerve supply. 

A reservoir in the pelvis, partially covered by peritoneum, 
consisting of involuntary muscular fibers extending in longi- 
tudinal and circular directions, a submucosa and a mucous 
membrane, the latter possessing transitional, squamous epithe- 
lial cells. Blood supply is from internal iliac artery, through 
superior, middle and inferior vesical branches; nerve supply 
is from pelvic plexus of sympathetic and from 3rd and 4th 
sacral nerves. 

Describe the testes. 

They are two seminal glands contained within the scrotal 
cavity, suspended by the spermatic cord, and surrounded by 
a peritoneal process, the tunica vaginalis testis. Each gland 
consists of a fibrous stroma, the tunica albuginea, dividing 
the interior into compartments which contain the seminiferous 
tubules, the latter converging toward the posterior part of 
the gland, and emerging to constitute the epididymis. 






PHYSIOLOGY. 



Explain the physiological circuit essential to a reflex 
action. 

The essentials are an afferent nerve, a nerve center, an 
efferent nerve and the peripheral organ which it supplies. 

Mechanical irritation of the sensory fibers of the vagus in 
the mucous membrane of the stomach causes an increased 
flow of saliva by irritation of the salivary center in the 
medulla and consequent passage of efferent impulses to the 
salivary glands. 

What is the function of the sixth (abducens) nerve? 

The abducens is the motor nerve of the external rectus. 

Describe the respiratory function of the red blood cor= 
puscles. 

"When the venous blood reaches the capillaries sur- 
rounding the air vesicles of the lung, the hemoglobin found 
in the red corpuscles rapidly combines with the absorbed 
oxygen to form oxyhemoglobin. This is carried back to the 
heart and then into the systemic circulation, finally reaching 
the capillaries. Here the tissues take the oxygen from the 
loosely combined oxyhemoglobin. The hemoglobin is then 
carried back to the lungs to be reoxygenated. The cor- 
puscles also carry small amounts of carbon dioxide from the 
tissues to the lungs. 

Describe the normal pulse; state the factors active in 
its maintenance, and give the average rate during infancy, 
youth and adult age. 

The pulse is the transmission of the cardiac impulse through - 
5 (65) 



66 PHYSIOLOGY. 

out the arterial system. A normal pulse should be full, of 
moderate tension, regular and of the right frequency. It is 
ordinarily examined over the radial artery at the wrist, 
because in this position there is a hard surface against which 
we can press the artery. 

The factors active in its maintenance are the normal action 
of the heart and of the vasomotor system. 

The average rate during infancy is 130 to 140; during 
youth 80 to 90; during adult life 70 to 75. 

Name the active principles of the digestive secretions 
and state how each affects the food. 

Ptyalin of saliva changes starch into maltose. 

Pepsin, when hydrochloric acid is present, changes pro- 
teids into peptones. 

Rennin changes caseinogen into casein. 

Amylopsin changes starch into maltose. 

Steapsin splits up fat into fatty acid and glycerin. 

Trypsin, in an alkaline medium, changes proteids into 
peptones. 

Invertin changes maltose into dextrose, and saccharose 
into equal parts of dextrose and levulose. 

Bile contains no ferment, but aids the pancreatic secretion 
in the emulsification of fats. 

From what portions of the cortex cerebri do the arm, 
face and leg receive their motor impulses? 

The motor area is along the fissure of Rolando in the as- 
cending frontal, ascending parietal and paracentral convolu- 
tions. The leg center is the uppermost, the arm center next, 
and the face center the lowermost. 

Describe the position of the vocal chords during phona= 
tion and name the factors concerned. 

The chink of the glottis during phonation is narrowed, 
the arytenoid cartilages are approximated and the vocal cords 
are stretched. The arytenoid muscle approximates the ary- 
tenoid cartilages, and with the help of the lateral crico-ary- 



PHYSIOLOGY. 67 

tenoids and the internal part of the thy ro- arytenoids closes 
the glottis. The vocal cords are made tense by the crico- 
thyroids and external part of the thy ro- arytenoids. 

Give the origin of normal fat in the human body and 
name examples of the types of food from which it is 
elaborated. 

The normal fat of the body is derived from food ingested. 
Any excess of food is stored up as fat. Fat may be elabor- 
ated from fats ingested as olein, from carbohydrates as starch, 
or from proteids as casein. 

Describe a complete physiological revolution of the 
heart. 

During diastole the blood from the auricles passes into 
the ventricles. Toward the end of diastole the auricles 
contract, forcing the blood remaining in them into their 
respective ventricles ; the ventricles now contract, the auriculo- 
ventricular valves are closed and the blood is forced into the 
pulmonary artery and aorta through the open semilunar 
valves; the ventricles now relax, the semilunar valves clos- 
ing with a snap and the auriculo- ventricular valves being 
opened by the force of blood in the auricles and by the nega- 
tive pressure in the ventricles. 

If the cardiac revolution were divided into tenths, the first 
or systolic sound would occupy four- tenths, the short silence 
one-tenth, the second or diastolic sound two-tenths, and the 
long silence three-tenths. 

Describe the process of respiration. 

Respiration is the function of taking in oxygen and the 
throwing off carbon dioxide. This exchange of gases takes 
place in the air vesicles where the blood and atmospheric air 
are separated by but a single layer of squamous epithelium. 

Three factors are concerned in this exchange — the law of 
pressure of gases, chemical affinity, and the vital activity 
of the epithelium. 

In tissue respiration the oxygen passes through the endo- 



68 PHYSIOLOGY. 

thelium forming the capillary wall, into the tissue, where it is 
used up. The carbon dioxide so formed passes from the tis- 
sues into the capillaries and thence to the lungs. 

What are the functions of the blood=vessels? 

Through the blood-vessels the blood is forced to the various 
parts of the body, carrying nutritive products to the tissues 
and waste from the tissues to the organs that excrete it. By 
their muscular wall they regulate the amount of blood going 
to various portions of the body, and together with the elastic 
tissue they contain also reduce the amount of work thrown on 
the heart. Through the capillary wall osmosis and diape- 
desis take place. 

Name and describe the normal respiratory sounds of the 
lungs and bronchi. 

The vesicular sound is a distant, soft, breezy sound, of 
low pitch, with the inspiration three or four times longer 
than expiration. It is caused by air passing through the 
bronchi, the sound being modified by the air vesicles. The 
bronchial sound is caused by the air rushing in and out of 
the bronchi. It is high pitched, loud, tubular in quality, the 
expiration being to inspiration as seven is to six. 

Of the functions of vision, what is understood by ac= 
commodation? 

By accommodation is meant the increasing of the curvature 
of the anterior surface of the crystalline lens to focus near 
objects on the retina. 

Describe the action of the kidneys, and give the normal 
constituents of the urine. 

The kidneys are compound tubular glands that pick out 
from blood certain waste material which passes down the 
tubules into the pelvis of the kidneys and then into the 
bladder. 

But one constituent of the urine is formed in the kidney 
and that is hippuric acid. 



PHYSIOLOGY. 69 

The water filters through the glomeruli principally, while 
the urea is picked out by the rodded epithelium of the con- 
voluted tubules. No proper secretory nerves have as yet been 
found for the kidneys, which seem rather to be controlled by 
the vasomotor system. The kidneys have possibly an in- 
ternal secretion also. 

The normal constituents of the urine are — water, urea, 
uric acid, hippuric acid, sodium chloride, potassium and 
sodium sulphates, conjugate sulphate as indican, earthy and 
alkaline phosphates, sometimes carbonates and oxalates, and 
the coloring matters urochrome, urobilin and uroerythrin. 

Describe gastric digestion, with special reference to the 
changes effected upon the types of food. 

When the food reaches the stomach the two openings close 
and the involuntary muscle contracts down on the mass and 
starts up a churning-like movement, by which fresh portions 
of food are constantly brought to the surface. At the end 
of an hour the pyloric orifice gradually relaxes, allowing some 
of the more liquid chyme to pass into the duodenum, and by 
the end of three or four hours even the larger pieces of un- 
digested food are forced into the duodenum. During this 
time the gastric juice is being poured out from the mucous 
membrane. The act of mastication and deglutition and the 
irritation of sensory vagi endings in the stomach by the food 
act as powerful reflex excitants to this secretion. 

The ptyalin of the saliva continues to change starch into 
maltose until the increasing acidity of the gastric juice stops 
its action. 

The fats are liquified, but it is upon the proteids that the 
chief action takes place. The rennin changes caseinogen 
into casein. The pepsin in the presence of the hydrochloric 
acid changes the proteids into proteoses and peptones. 

Describe the process of segmentation of the ovum. 

The impregnated ovum first divides into two cells by in- 
direct division or karyokinesis, these again subdivide, con- 
tinuing until finally a single layer of cells surrounding a 



70 PHYSIOLOGY. 

central cavity is formed. One group of cells proliferates 
more rapidly than the other and as a result they become sur- 
rounded by the other layer; thus two leaves are formed. 
Between these a third layer or mesoblast is formed. From 
this blastoderm the animal is now developed. 

What is the relation of the capillaries to the circulation? 

The capillaries connect the small arterioles with the small- 
est veins. They are situated at the periphery. 

What precautions should be taken in the ingestion of 
vegetable foods? Give the reasons for taking these pre= 
cautions. 

Vegetable foods should be well cooked so as to burst the 
cellulose covering of the starch granules; they should be 
well chewed so as to break up the cellulose covering. Some 
fatty food should be taken with them as they are deficient 
in fats. As some of them contain but little nutritive ma- 
terial, they should be taken in large quantities for obvious 
reasons. 

Describe the process of osmosis and give examples in 
the human economy. 

Osmosis is the diffusion of liquids through a porous mem- 
brane. 

For osmosis to take place the liquids must be miscible, of 
different natures, capable of wetting the membrane without 
acting on it chemically, and the substance must be able to 
pass through the membrane, that is, be crystalloidal in nature. 
Heat, increase of pressure and electricity aid osmosis. 

The following are examples of osmosis: (1) The passage 
of some of the plasma through the capillary wall into the 
tissues. (2) The passage of glucose from the intestine into 
the portal circulation. 

Name the secretions of the alimentary canal and give 
the functions of each. 

Saliva changes starch into maltose, dissolves soluble sub- 



PHYSIOLOGY. 71 

stances, thus allowing them to be tasted, lubricates the bolus 
of food and aids in speech. 

Gastric juice changes caseinogen into casein, and proteids 
into proteoses and peptones. It also destroys many micro- 
organisms swallowed in the food. 

Pancreatic secretion changes proteids into peptones, starch 
into maltose, caseinogen into casein, and splits up, saponifies 
and emulsifies fats. 

Bile neutralizes the acid chyme precipitating the pepsin, 
aids in the emulsification and absorption of fats, increases 
peristalsis, prevents excessive putrefaction, and contains some 
waste thrown off by the liver. 

Succus entericus changes maltose into glucose, and sac- 
charose into invert sugar. 

The alimentary canal has also the usual protecting and 
lubricating secretion of mucus. 

Describe urea, its occurrence, variations in the quantity 
excreted and recognition in the voided urine. 

Urea, CO(NH 2 ) 2 , the great nitrogenous waste, is a crystal- 
lizable substance soluble in alcohol and water, neutral in 
reaction and forming with nitric acid urea nitrate. About 
500 grains daily are thrown off in the urine by the kidneys. 
It is formed in the liver ( -§-) and in the intestines (^). It 
varies principally with the amount of nitrogenous food in the 
diet. Muscular exercise does not increase it to any marked 
extent. It is recognized by adding nitric acid to a concen- 
trated urine when urea nitrate separates out in a crystalline 
mass, also by the hypobromite test. 

What is rigor mortis? What is tetanus? 

Rigor mortis is the post-mortem rigidity of the muscles due 
to the coagulation of the myosinogen. 

Tetanus is a state of continued contraction of a living 
muscle. 

Give the varied functions of the sympathetic nerve. 

The function of the sympathetic system is mainly vaso- 



72 PHYSIOLOGY. 

motor. It also supplies the heart with accelerating fibers, 
the intestines with inhibitory and some motor fibers; dilates 
the pupil, and causes a bulging of the eyeball. It also has 
an influence on the salivary secretion. 

How are the phenomena of ventriloquism produced? 

Instead of the usual expiratory blast, an inspiratory blast 
is used in producing the vocal sounds. At the same time 
the operator directs the attention of the onlookers to some 
object. 

Describe the mechanism of micturition. 

Usually it is a mixture of a voluntary and involuntary re- 
flex act. The reflex center is situated in the lumbar cord. 
Stimulation of this center is ordinarily caused by a full 
bladder or by the escape of a drop of urine into the urethra, 
but may be excited by irritation of sensory nerves of other 
surfaces, as the intestinal mucous membrane by worms. 
Ordinarily the sphincter of the bladder is inhibited, the 
muscular wall contracts, and aided by the abdominal and 
other expiratory muscles forces the urine out through the 
urethra. There are higher centers that have control over 
the lower reflex centers. 

Name the ferments that are the essential constituents 
of each digestive fluid. 

Ptyalin is found in saliva; pepsin and rennin in gastric 
juice; amylopsin, steapsin, trypsin and a milk-curdling fer- 
ment in the pancreatic juice ; invertin in the succus entericus ; 
and the micro-organisms or organized ferments in the in- 
testines. Bile contains no ferment. 

What are the functions of the spinal cord? 

The spinal cord is the great motor and sensory pathway 
to and from the periphery. In the anterior horns are found 
the cells concerned in the muscular reflexes, and also the 
trophic centers for the muscles. Beside the muscular reflex- 
centers, the cord contains the following centers: Anospinal, 



PHYSIOLOGY. 73 

vesicospinal, genitospinal, uterospinal, sweat, minor vaso- 
motor and possibly ciliospinal. 

What post=mortem tests should be applied to prove that 
air has entered the lungs of a supposedly still=born child? 

Tie the trachea, take out the lungs and place them in 
water. If they float, air has entered the lungs. The thorax 
is not as flat after respiration has started and the diaphragm 
is displaced further downward. The lungs are brighter in 
color and are crepitant after air has once entered. 

Wherein does the temperature of the body in advanced 
age differ from its temperature in middle life? 

In advanced age the temperature has a tendency to be- 
come subnormal from the slightest cause. 

Give in language or by drawing the sphygmographic 
tracing in aortic insufficiency. 

In aortic insufficiency there is the so-called "trip hammer 
pulse. ' ' In the sphygmogram there is a very high, quick up 
stroke and an almost as quick downstroke due to the rapid 
decrease in pressure caused by the regurgitation. On the 
downstroke a small dicrotic wave is seen. 

What are amyloid foods, proteid foods? Give three ex= 
amples of each. 

The amyloid foods are the carbohydrates in the molecule 
of which are six or multiple of six atoms of carbon, and 
hydrogen and oxygen in the proportion to form water. 
Starch, cane sugar and glycogen are amyloids. 

Proteids are highly complex bodies containing carbon, 
hydrogen, oxygen, nitrogen, sulphur and sometimes phos- 
phorus. Egg albumen, casein and gluten are proteids. 

How is cartilage (a) developed, (b) nourished? 

Cartilage is developed from the mesoblast. The cells are 
not branched. By , karyokinetic changes they divide and 
subdivide. Each cell is surrounded by a capsule which helps 



74 PHYSIOLOGY. 

to form a portion of the matrix. But beside this, other 
material is deposited in the intercellular spaces. 

Cartilage is nourished by the perichondrium except arti- 
cular cartilage, which is nourished from the underlying bone. 

Describe nerve cells and nerve fibers. 

The nerve cells are nucleated masses of granular proto- 
plasm with one or more protoplasmic prolongations called 
dendrons. Passing off from most nerve cells is a long fiber 
or axis cylinder. 

The nerve fibers are either medullated or non-medullated. 
The medullated fibers consist of an axis cylinder or neur- 
axon, surrounded by the myelin or white substance of 
Schwann, which in turn is covered with the neurilemma or 
sheath of Schwann. An internal layer of protoplasm sepa- 
rates the myelin from the neuraxon, and an external layer 
separates the myelin from the neurilemma. Here and there 
along the course of the nerve are found the nodes of Ranvier. 
The non-medullated fibers contain no myelin. 

What experiments have been made to prove the glyco= 
genie function of the liver? 

The blood of the portal vein during active digestion of a 
carbohydrate meal contains more sugar than the hepatic 
vein, showing the arrest of dextrose in the liver. The hepatic 
vein in the intervals of digestion contains twice as much 
dextrose as that in the blood entering the liver. 

If a rabbit that has been fed on carrots is killed and the 
liver rapidly removed, cut into small pieces and thrown into 
boiling water, it yields an extract rich in glycogen and al- 
most free of dextrose. 

If another animal is treated the same but the liver al- 
lowed to stand for some time before making an extract, the 
extract will contain much dextrose and but little glycogen. 

The carbohydrate of blood is dextrose and not glycogen. 
Under the microscope, glycogen granules are found in the 
protoplasm of the liver cells. 



PHYSIOLOGY. 75 

In what glands of the body is the function undeter= 
mined? 

With the exception of being able to say that they are all 
probably connected with general metabolism, the functions 
of the following glands are undetermined: Pituitary body, 
thymus, coccygeal gland. But little is known about the 
adrenals and thyroids. 

What is the normal ratio of respirations to heart pul= 
sation? 

In a healthy adult there are four pulse beats to one re- 
spiration. 

Give the foramen of exit, the distribution and the func= 
tion of the oculomotor nerve. 

The oculomotor nerve leaves the skull through sphenoidal 
fissure. It supplies motor filaments to the superior, in- 
ternal and inferior recti, the inferior oblique, the levator 
palpebrae, the ciliary muscle and the constricting fibers of 
the iris. 

What office does the Eustachian tube perform? 

It equalizes the pressure of the air on the membrana- 
tympani, thus facilitating hearing. 

Define leucomain. 

Leucomains are alkaloidal or basic substances formed in 
the living tissue by metabolism, waste in nature, some of 
them toxic. 

Give the present physiologic conclusions in respect to 
the presence of the corpus luteum as a sign of pregnancy. 

According to Tidy, "there may be pregnancy without the 
presence of a true corpus luteum, and also bodies indis- 
tinguishable from true corpora lutea may be found where 
there has been no pregnancy." The presence of the true 
corpus luteum nevertheless is usually a sign of pregnancy. 



76 PHYSIOLOGY. 

What effects are produced in the system by the removal 
of the thyroid gland? 

Removal of the thyroid gland is followed by peculiar de- 
praved condition of metabolism called cachexia strumipriva. 

Give the principal characteristics of gastric juice in man. 

G-astric juice is an acid limpid secretion with a specific 
gravity of about 1005, quantity ten pints daily. It contains 
especially pepsin, rennin and hydrochloric acid. 

How can fresh blood stains be distinguished from older 
blood stains? 

Fresh blood stains are brighter in color and the clot is 
flexible ; the older stain is darker and the clot is fragile. 

Describe color blindness and name the colors which the 
subject commonly fails to distinguish. 

Color blindness is the inability to perceive certain colors. 
The colors commonly indistinguishable are red and green. 

What are the functions of the brain membranes? 

The dura mater is tough and protecting, and also acts as 
internal periosteum to the bones of the head. 

The arachnoid is a thin spider-like membrane covered 
with endothelial cells that secrete cerebrospinal fluid. 

The pia mater is a vascular membrane dipping down into 
the sulci and carrying blood to the cortex. 

Name the solids in the urine and state the approximate 
amount of each voided daily by an adult. 

Urea 500 grains ; chloride of sodium 180 grains ; sulphates 
(sodium and potassium) 30 grains; phosphate (earthy and 
alkaline) 45 grains; uric acid 7 grains; hippuric acid 7 
grains; and small quantities of various pigments and other 
organic matter. 

Describe the factors which cause the heart sounds. 

The first sound is due to the sound of muscular contraction 
and to the closure of the auriculo-ventricular valves, as the 



PHYSIOLOGY. 11 

blood tends to regurgitate into the auricles during ventri- 
cular systole. 

The second sound is due to the closure of the semilunar 
valves, as caused by the blood tending to regurgitate into 
the ventricles during diastole. 

What is the effect of an excessive meat diet? 

An excessive meat diet disturbs the general metabolism, 
causing diseased conditions associated with an increase in 
uric acid, as gout, rheumatism and migraine. 

Explain how the seminal fluid is conveyed to the vesi= 
culae seminales. 

It is conveyed to the vesiculae seminales by the vas deferens, 
which is the prolongation of the tube forming the epididymis. 
The vas deferens passes up from the testicles through the 
external and internal abdominal rings and to the vesiculae 
seminales on the posterior surface of the bladder. 

How and why is hearing affected by rupture of the 
membrana tympani? 

The membrana tympani, on account of its shape and the 
action of the tensor tympani, is capable of responding to 
many vibrations, and thus aids in the acuity of hearing. 

Describe cell growth. 

Cell growth is that peculiarity which living cells have of 
taking in new material and incorporating it into themselves, 
thus increasing in size. 

Describe the phenomena of (a) asphyxia, (b) syncope, 
(c) sleep. 

Asphyxia is the condition caused by a deficient supply of 
oxygen. In the complete shutting off of the supply of 
oxygen we have three stages. First, the stage of marked in- 
spiratory efforts or dyspnoea, lasting about one minute; 
second, the stage of convulsions with marked expiratory 
spasms, lasting about one minute ; and third, the stage of ex- 
haustion and finally death. 



78 PHYSIOLOGY. 

During the first stage the blood pressure begins to rise and 
heart becomes somewhat slower. During the second stage 
this rise in blood pressure is well marked and also the slow- 
ing of the heart. Toward the end of this stage as the re- 
spiratory movements cease unconsciousness ensues, the blood 
pressure falls and the heart becomes still slower, until death 
stops everything. 

Syncope is that condition of unconsciousness following a 
sudden depression of the vasomotor and cardiac nervous 
mechanism, causing anaemia of the brain. 

Sleep is a physiological condition of unconsciousness, due 
to a periodical need of the nervous system of rest. It is 
also due in part to the absence of external stimuli. It is ac- 
companied by an anaemia of the brain. 

Name, locate, and give the function of each of the vari= 
eties of epithelia. 

Epithelium secretes and protects the underlying tissues. 
Squamous epithelium, found in the mouth, protects the under- 
lying structures. Columnar epithelium, found in the intes- 
tinal mucosa, aids in the absorption of digested food products. 
Ciliated epithelium, found in the bronchial mucosa, forces 
dust and mucus up into the trachea to be coughed out. 
Cuboidal epithelium, found in the salivary glands, secretes 
saliva. Goblet-shaped epithelium, found in the mucous mem- 
branes, forms the mucous secretion. Stratified epithelium is 
composed of several layers, the uppermost generally squa- 
mous, and lowermost columnar. It forms the epidermis. 

Describe the lymphatic system. 

The lymphatic system consists of numerous small thin- 
walled vessels with many valves, commencing in the tissues 
as lymph capillaries and emptying into two large vessels 
that carry the contained lymph to the subclavian veins. In 
certain places along the course of the lymphatics, as in 
axilla and groin, are found groups of little glands called 
lymphatic glands. These consist of a cortical portion and 



PHYSIOLOGY. 79 

a medulla which is made of lymphoid tissue, in the center of 
which are a number of cells rapidly undergoing karyokinesis. 
All the lymphatics (including the lacteals of the intestine) 
with the exception of right half of the body from the dia- 
phragm upward, empty into the thoracic duct. This vessel, 
about the diameter of a goose quill, empties into the left 
subclavian vein. The lymphatics of the right side of the 
body from the diaphragm upward empty through a smaller 
vessel into the right subclavian vein. 

Describe the olfactory apparatus. What part of the 
olfactory apparatus is the seat of smell? 

The nasal cavities are divided into a lower or respiratory 
portion and an upper or olfactory portion. 

We find in the upper portion some broad supporting epithe- 
lial cells, and projecting upward from cells between these 
are little hair-like processes. The olfactory nerve ends in 
these specialized cells. The olfactory nerve passes from these 
cells through the olfactory bulbs and backward through three 
tracts to the cerebrum, ending for the most part in the uncus 
of the same side. 

What is the physiology of the so=caHed rest cure? 

The rest cure corrects faulty metabolism and brings the 
tissues again to their normal conditions. 

How is the descent of the testicle to the scrotum ac= 
complished? 

The descent of the testicle is now generally thought to be 
due simply to the arrangement of the organs due to the 
process of development and not to the traction of muscular 
cord, as formerly thought. 

Describe the growth and the development of the teeth. 

The first step in the formation of the teeth is the down- 
ward growth of the epithelium covering the rudimentary jaw. 
This forms the enamel germ, which develops especially at cer- 
tain points. A little vascular papilla now grows upward 



80 PHYSIOLOGY. 

into this enamel germ; thus we have the rudimentary teeth. 
The adamantoblasts of the enamel germ form the enamel, and 
the odontoblasts form the dentine which covers in the dental 
pulp. The crusta petrosa is formed from the cells forming 
the dental periosteum. 

What is the condition of the eyeball in myopia? How 
may it be corrected? 

In myopia the eyeball is too deep, causing the rays of 
light to be brought to a focus in front of the retina. It is 
corrected by a concave lens. 

Define physiologically the term cell. How are cells re= 
produced? 

A cell is a nucleated mass of protoplasm. 
Cells are reproduced by direct division, indirect division 
or karyokinesis, and endogenous nuclear multiplication. 

Describe the physical characteristics of cartilage. What 
is temporary cartilage, permanent cartilage? Illustrate. 

Cartilage is a firm, elastic, white or yellow- white sub- 
stance. 

Temporary cartilage is that which afterward is formed 
into bone, as the fetal femur. 

Permanent cartilage is that which remains as cartilage dur- 
ing life, as articular cartilage. 

Describe the white blood corpuscles, giving source, com= 
position and properties. 

The white blood corpuscles are nucleated masses of granu- 
lar protoplasm, about ^Vo m - m diameter and capable of 
amoeboid movement and phagocytic action. 

As to the varieties, we find the small lymphocyte, the larger 
transitional, the polymorpho-nuclear, and eosinophile con- 
taining large granules staining readily with eosin. Occas- 
ionally a basophile can be found. 

The white cells are developed from the lymphatic tissues, 
the spleen and the marrow of bone. Chemically they con- 
tain nuclein, a globulin, fat, glycogen and a nucleoproteid. 



PHYSIOLOGY. 81 

What changes are produced in the air and in the blood 
by respiration? 

The expired air contains less oxygen and more carbon 
dioxide, nitrogen, and water than inspired air. It also con- 
tains certain volatile organic substances and is warmer than 
the inspired air. 

The blood leaving the lungs contains more oxygen and less 
carbon dioxide and nitrogen than that entering the lungs. 

Define aphonia, aphasia. Give the cause of one of these 
conditions. 

Aphonia is the loss of voice, or the power of phonation. 
Aphasia is the inability to give the proper word symbol. 
Motor aphasia is due to a lesion of the left lower frontal 
convolution or of the fibers coming from it. 

Describe the normal heart sounds. 

The first sound is twice as long as the second, lower in 
pitch and with a prolonged dull, somewhat booming quality. 
It is caused by the closure of the auriculo-ventricular valves 
and the sound of contracting muscular walls of the ventricles. 
It is heard best at the apex, and is systolic in time. 

The second sound follows the first after a short interval. 
It is short, snapping in quality and is higher pitched than 
the first. It is caused by the closure of the semilunar valves 
and is diastolic in time. It is heard best at the base of the 
heart. 

State the physiologic uses of the large intestine. 

Into the large intestine the crypts of Lieberkuhn pour in 
some secretion and the microbic digestion goes on. Although 
no villi are found here part of the food not already absorbed 
is taken up. The feces are concentrated and collected in the 
lower end of the intestine, to be expelled during the act of 
defecation. 
6 



82 PHYSIOLOGY. 

Define (a) tonic muscular contraction, (b) clonic mus- 
cular contraction. Give an example of each. 

Tonic muscular contraction is a continued contraction, as 
the action of sphincter ani. 

Clonic muscular contraction is an intermittent or remittent 
muscular contraction as seen in the jerking movements of a, 
convulsion. 

Define reserve air, residual air, complemental air, 
tidal air. 

Reserve air is the amount of air that can be expired after 
an ordinary expiration, about 100 cubic inches. 

Residual air is the amount of air left in the lungs after 
the most forcible expiration, about 100 cubic inches. 

Complemental air is the amount of air that can be taken in 
after an ordinary inspiration, about 100 cubic inches. 

Tidal air is the amount of air taken in with each ordinary 
inspiration, about 30 cubic inches. 

What are the respective functions of the anterior and 
of the posterior cornua of the spinal cord? 

The anterior cornua are motor in function and are the 
trophic centers for the muscles. 

The posterior cornua are mostly relay stations on the sen- 
sory pathway. 

What explanation may be given for enlargement of the 
spleen in leucocythemia? 

The spleen is one of the organs in which white corpuscles 
are formed. 

Give the difference between the temperature of a new= 
born child and that of an adult, between the temperature 
of a person intoxicated by alcoholic drink and his tem= 
perature after the first stimulating drink of liquor. 

Immediately after birth the temperature is somewhat above 
normal, but soon becomes subnormal. At the end of twenty- 
four hours it has again reached normal and remains so. A 



PHYSIOLOGY. 83 

small dose of alcohol causes a slight rise in temperature; 
large doses, as in one intoxicated, cause a subnormal 
temperature. 

In a healthy man, what time is consumed in the diges« 
tion of an ordinary meal of meat, vegetables and bread? 

The food remains from two to four hours in the stomach 
and about six hours in the small intestine. Digestion is 
practically finished before it leaves the small intestine. 

Define human physiology. 

Human physiology is the study of the phenomena of the 
living human body. 

Give the causes of muscular fatigue. 

Muscular fatigue is caused by the accumulation of waste 
products in the muscles. 

The seat of fatigue, as we ordinarily speak of it, is first in 
the central nervous system, then in the motor end plates, 
then the muscle and finally the nerve trunks. 

What effect is produced on the heart's action by stimu- 
lation of the cardioinhibitory center? 

There is a slowing of the heart, or, if the stimulus is great 
enough, a stoppage of the heart in diastole. 

Why does blood remain fluid in the body in life, and 
coagulate when shed? 

The intima has some unknown peculiar action on the blood. 
The blood does not clot until the disintegration of the 
white corpuscles sets free the fibrin ferment. 

What conditions produce variations in the normal tem- 
perature of the body? 

Anything that will disturb the proper balance of heat pro- 
duction and heat dissipation will cause a variation from the 
normal temperature. 

Normal physiological variations are caused by digestion, 
muscular exercise, menstruation, bathing and excitement. 



84 PHYSIOLOGY. 

Drugs, as eocain, atropine, alcohol, acetanilid, may cause 
variations from the normal; as will also hypodermic in- 
jections of proteoses and peptones, shock, toxins of bacteria 
and exposure to excessive changes in temperature of at- 
mosphere. 

Give the nervous mechanism of urination. 

The bladder is supplied with nerves from the lower dorsai 
and upper lumbar nerves and also with branches from the 
sympathetic system. The act of urination may be completely 
involuntary, the reflex center being in the lumbar portion 
of the spinal cord and set in action by afferent impulses 
from a distended bladder or from irritation possibly of the 
mucous membranes. Ordinarily the abdominal muscles aid 
voluntarily in urination. 

There is probably a higher voluntary center and also an 
inhibitory one. 

Describe the human blood. 

Blood is a red, alkaline fluid, salty and nauseating in taste, 
with a peculiar odor. It has a specific gravity of about 1055. 
It is composed of a liquid portion called plasma, and a solid 
portion, the red and white corpuscles. In the plasma we 
find serum albumin and globulin, fibrinogen, various salts, 
especially sodium, potassium and calcium, and small quan- 
tities of dextrose, fats and extractives. The hemoglobin is 
found in the red corpuscles. 

What is the purpose of respiration? Give the mechan- 
ism of respiration. 

During the act of respiration oxygen is absorbed and car- 
bon dioxide is thrown off. 

During inspiration the diaphragm descends, the ribs are 
elevated and rotated outward; the cavity of the thorax is 
thus enlarged and the air rushes in to fill up the partial 
vacuum ; the muscles now relax and the elasticity of the chest 
wall and lungs forces a portion of the air out. These move- 
ments are controlled by the respiration center in the medulla. 



PHYSIOLOGY. 85 

Describe the bile=producing and the glycogenic function 
of the liver. 

Bile is produced by the activity of the liver cells chiefly 
from the blood from the portal vein. It is collected in little 
canals hollowed between the cells and emptied into the bile 
capillaries. Through these it is forced on into the bile duct 
and either passed on into the duodenum during the act of 
digestion, or stored in the gall bladder until needed. 

Glycogen or animal starch is formed by the protoplasmic 
activity of the liver cells from proteids and carbohydrates. 
It is deposited in the liver cells and when needed is changed 
into dextrose by a diastatic ferment found in the blood of 
the liver. This dextrose is carried out in the blood of the 
hepatic vein into the general circulation. 

Give a dietary for people beyond the age of sixty years. 

Food for the aged should be readily digestible and capable 
of being easily burned up for the maintenance of the heat 
of the body. Among these articles are eggs, milk, rice, prop- 
erly cooked beef, butter and bread. 

What is the function of the cerebellum? 

The function of the cerebellum is the co-ordination of 
muscular movements. 

Describe ciliated epithelium and state where it is found 
most abundantly. 

The cells of ciliated epithelium are generally columnar in 
shape with numerous fine filaments projecting from their free 
surface. Ciliated epithelium is found most abundantly in the 
trachea and bronchi and here sweeps the mucus and small 
dirt particles toward the mouth. 

Give a description of the act of deglutition and mention 
the muscles brought into action in swallowing. 

The swallowing of solids is divided into three stages — 
buccal, pharyngeal and esophageal. The first is voluntary, 
the others involuntary. The food is formed into a bolus and 



86 PHYSIOLOGY. 

pressed backward by the tongue into the pharynx ; the nasal 
cavities being closed, the pharyngeal muscles contract and 
force it on down to the esophagus. This in turn contracts 
and by a peristaltic movement forces the bolus into the 
stomach. 

Liquids are not swallowed in this way, but are squirted 
down the esophagus, with a bulb syringe effect, by the 
mylohyoid muscle. The muscles involved in deglutition are 
the mylohyoid, muscles of the tongue, pharyngeal muscles, 
especially the constrictors and the involuntary muscular 
fibers of the esophagus. 

How is asphyxia produced? What are the causes of 
death from asphyxia? 

It is produced by anything causing a deficiency in the 
supply of oxygen to the tissues, as oedema of lungs, membran- 
ous laryngitis, constriction of the trachea. 

Death is caused by a deficiency in the amount of oxygen 
and the accumulation of carbon dioxide in the blood. The 
respiratory center is probably the first one to be disabled. 

Describe (a) chyme, (b) chyle. 

Chyme is the acid semi-fluid mass of partially digested food 
passing from the stomach into the duodenum. 

Chyle is the lymph found in the lacteals of the intestines 
containing the absorbed fat. It is a milky white, alkaline 
fluid. 

Give the process of coagulation of blood. 

The fibrin ferment formed by the disintegration of the 
white corpuscles in the shed blood acts upon the fibrinogen 
and converts it, if calcium salts are present, into the insol- 
uble fibrin. The fibrin is formed in little filaments all 
through the blood and immeshes the blood corpuscles. This 
forms the clot which gradually begins to contract. A liquid 
called serum soon exudes and collects over the clot. 



PHYSIOLOGY. 87 

How is bone nourished? 

Bone is nourished by the nutrient arteries through the 
Haversian system of canals and by the periosteum. 

State the function of the anterior spinal nerve roots. 
How is the function proved? 

The anterior roots are motor. 

Section of the anterior roots causes motor paralysis of 
the parts that they supply. Irritation of the peripheral ends 
causes contraction of the muscles they supply. Irritation of 
central ends has no effect ; no sensation is felt. 

Give illustrations of morbid reflex action. 

The vomiting of pregnancy is caused renexly by irrita- 
tion of mucous membrane of uterus. 

Faulty digestion may cause renexly palpitation of the 
heart. 

What is the composition of urine? Give the normal re- 
action and specific gravity of urine. 

Urine is composed of 96% water and 4% solids, one-half of 
which is urea. The other half is made up of phosphates 
(earthy and alkaline), sulphates of sodium and potassium, 
chloride of sodium, uric acid, hippuric acid, extractives and 
the coloring matters — indican, urobilin and urochrome. 

The normal reaction of urine is acid and the specific grav- 
ity 1020. 

Describe the temporary and permanent teeth. 

The temporary or milk teeth are twenty in number, ten in 
each jaw. From the front backward we have in each side 
of the jaw two incisors, one canine and two molars. The 
first tooth to erupt is the lower central incisor about the sixth 
month. This set is complete about the thirtieth month. 
About the sixth year the jaw has enlarged considerably; as 
a result there is room for another tooth and the first per- 
manent tooth, the six-year molar, erupts. Then the incisors 
are erupted, pushing out in front of them the temporary 



88 PHYSIOLOGY. 

teeth. The last permanent tooth to erupt is the third molar 
or wisdom tooth, about the twenty-first year. 

There are thirty- two permanent teeth, sixteen in each jaw. 
From the front backward in each side of the jaw we have 
two incisors, one canine, two bicuspids and three molars. 
The incisors cut the food, the canines tear it and the molars 
grind it. 

Through what medium is the blood relieved of effete 
matter and provided with new material? 

The blood is relieved of effete materials through the sweat, 
urine, feces and exchange of respiratory gases in the lungs. 

It is provided with new material through the respiratory 
exchange of gases, from the gastrointestinal tract through 
the portal vein and lacteals, and from the ductless glands, as. 
the thyroid, spleen, adrenals; also from marrow of bones. 

How is normal body temperature regulated and sus- 
tained? 

It is regulated by the thermotaxic centers of the nervous 
system, and sustained by metabolism of the tissues, especially 
the muscular and glandular. 

State where in the human economy the following sub- 
stances are found: fibrin, chondrin, leucin, hippuric acid. 

Fibrin is found in clotted blood, chondrin in cartilage,, 
leucin in the intestines, hippuric acid in urine. 

What stimuli produce muscular contraction? What is 
the nervous mechanism of muscular contraction? Illus- 
trate. 

Stimuli producing muscular contraction are the normal 
nervous stimulus, electrical, mechanical, chemical, and 
thermal. 

In the nervous mechanism of muscular contraction, the 
motor impulse starts from the motor nerve cell, passing down 
the motor neuraxon to the motor end plates, and here the 
muscle cells are stimulated to contract. One stimulus would 



PHYSIOLOGY. 89 

simply cause a muscular twitch, but normally in a muscular 
act a series of impulses are sent from the nerve centers to 
keep the muscles in a voluntary tetanus. 

In raising the foot the motor impulse starts in the cere- 
bral grey cells of the Rolandic area, passes down to the cells in 
the anterior horn of the opposite side of the lumbar cord, then 
out through the sciatic nerve to the motor end plates of the 
muscles required to lift the foot, which in turn stimulate 
the muscular fibers. 

Define stammering and state what causes it. 

Stammering is a defect of speech due to the spasmodic 
action of the diaphragm interrupting the flow of air past the 
vocal cords. The larynx and lips are under control. 

Define and describe respiratory rhythm, respiratory 
sounds. 

Respiratory rhythm is the relation between the time of in- 
spiration and expiration. Inspiration is to expiration as five 
is to six, the expiration being followed by a short pause. 

The respiratory sounds are the sounds heard in auscultating 
the lungs. There are two sounds. One is the vesicular 
breathing, which is a low-pitched, soft, distant breezy sound, 
the inspiration being to expiration as three or four is to one, 
in fact expiration may be a mere puff. 

The second is the bronchial breathing, heard over the 
trachea and primary bronchi. It is high-pitched, blowing or 
tubular in quality, the expiration being louder, a little longer 
and higher pitched than inspiration. 

What are the functions of the skin and its appendages? 

The skin and its appendages protect from drying and 
other injury the underlying tissues, especially the end or- 
gans of the sensory nerves in the skin. The hair prevents 
friction and also protects sensitive parts from extremes of 
temperature. On account of the large extent of its surface 
and also on account of the sweat glands it contains, the skin 
is a great heat-dissipating organ. 



90 PHYSIOLOGY. 

Define myopia, hypermetropia, astigmatism. State the 
cause of each of these conditions. 

Myopia or nearsightedness is a defect in vision in which 
parallel rays of light are focussed in front of the retina. It 
is due usually to an increased length in the anteroposterior 
diameter of the eye. ' , 

Hypermetropia or farsightedness is a defect in vision in 
which parallel rays of light are brought to a focus beyond 
the retina. It is generally due to a shortening of the an- 
teroposterior diameter of the eye. 

Astigmatism is an error of refraction in which rays of light 
in the various planes are not equally refracted, some of the 
rays possibly being focussed on the retina, others behind or 
in front of it. It is generally due to irregularities in the 
curvature of the cornea, but sometimes of the lens. 

What is the physiologic function of the liver? 

The liver secretes bile, forms glycogen, urea, uric acid, con- 
jugate sulphates, destroys some of the red corpuscles and in 
fetal life forms some red corpuscles. It also destroys many 
poisons taken into the body. 

State the manner in which blood circulates through the 
heart and the lungs, beginning at the right auricle. 

The blood passes from the right auricle through the tri- 
cuspid valve into the right ventricle; thence through the 
pulmonary valve into the pulmonary artery, which divides 
and subdivides, finally ending in the capillaries around the 
air cells. The blood is re-collected and emptied by the pul- 
monary veins into the left auricle; then it passes on through 
the mitral valve into the left ventricle; it is then forced out 
through the aortic valve into the aorta. 

Compare arteries, veins and capillaries in respect to 
rapidity of the blood stream. 

The blood flows in the arteries at about the rate of twelve 
inches a second, in the veins seven inches a second, and in the 
capillaries two inches a minute. 



PHYSIOLOGY. 91 

What tests should be applied to ascertain the integrity 
of (a) the superficial reflexes, (b) the deep reflexes? 

To ascertain the integrity of superficial reflexes we have 
the plantar reflex or movement of the toes on stroking the 
sole of the foot; the cremasteric, the retraction of testicle on 
gently stroking the inside of the thigh; the epigastric, con- 
traction of abdominal muscles on stroking the side of the 
abdomen ; the ciliospinal, dilatation of the pupil on pinching 
the skin ; and many others. 

Of the deep reflexes, the knee jerk is the one usually sought 
after. On tapping the tendon below the patella the quadri- 
ceps is thrown into action. We also have a bicipital reflex 
or contraction of biceps on tapping the tendon at the elbow. 

What would be the effect of a transverse section of 
(a) the anterior root of a spinal nerve, (b) the posterior 
root of a spinal nerve? 

Transverse section of the anterior root would cause motor 
paralysis of the muscles it supplied, and finally atrophy of 
the muscles. 

Transverse section of the posterior root would cause loss 
of sensation of the part it supplied. 

Describe the physical properties of (a) lymph, (b) chyle. 

Lymph is a yellowish, salty, albuminous liquid, with a 
specific gravity of 1015. On exposure to air it clots and 
coagulates on heating. 

Chyle is simply lymph plus the minute globules of absorbed 
fat, and is milky white in color. 

How does impairment of the function of one of the fol- 
lowing affect the other two: (a) the skin, (b) the lungs, 
(c) the kidneys. 

Impairment of the function of the kidneys causes increased 
activity of the skin; and at times dyspnoea, asthmatic at- 
tacks, urinous breath, Cheyne-Stokes breathing, and con- 
gestion of lungs. 



92 PHYSIOLOGY. 

Describe an epithelial secreting surface. 

The mucous membrane of the stomach consists of a layer 
of columnar epithelium resting on a layer of loose connective 
tissue, containing some involuntary muscular fibers and many 
small blood vessels and lymphatics. Dipping down from 
the epithelial layer are numerous small glands. These glands 
are lined with cubical epithelium and secrete the gastric juice. 

In the glands of the cardiac end and of the fundus, beside 
the cubical cells, we also find along the sides a number of 
spheroidal cells. These are the cells that form the hydro- 
chloric acid. 

Discuss the action of the gastric juice on carbohydrates 
and fats. 

The gastric juice has no effect on fats, except to melt some 
of them because of its temperature. 

As to the carbohydrates starch is unaffected, but the hy- 
drochloric acid probably inverts some of the cane sugar 
present in the food. 

Give the composition and uses of blood. 

The blood is composed of 60 parts plasma and 40 parts 
corpuscles. 

In a thousand parts of plasma ninety-eight are solid. The 
bulk of the solid matter is composed of the proteids, serum 
albumin, serum globulin and fibrinogen. Besides these we 
have various salts, especially compounds of sodium, calcium, 
potassium and magnesium in combination with chlorine, phos- 
phorus and carbon dioxide. There are also fats, urea, uric 
acid, dextrose and cholesterin. 

The red corpuscles are composed of water 69%, hemoglobin 
29%, and small quantities of other proteids, salts and ex- 
tractives. 

The white corpuscles contain globulin, albumin, nuclein, 
various salts and the mother body of fibrin ferment. 

The blood carries the absorbed food and oxygen to the 
tissues and carries away waste to the organs excreting them. 



PHYSIOLOGY. 93 

It also equalizes the temperature of the various parts of the 
body. 

Describe the process of absorption by (a) the blood= 
vessels, (b) the lymphatics. 

The digested food is carried through the columnar epithe- 
lium of the intestinal villi by the force of osmosis and the 
vital activity of the cells, the peptones being changed during 
their passage into albumins and globulins. The carbohy- 
drates, soluble salts and proteids pass into the capillaries 
and then on into the portal vein, which carries them to the 
liver. From here they pass out through the hepatic vein into 
the general circulation. The fats are taken up by the lacteals 
and carried to the receptaculum chyli and then up through 
the thoracic duct into the left subclavian vein. 

Describe the red blood corpuscles. Give the best known 
and most important function of the red blood corpuscles. 

The red corpuscles are non-nucleated, elastic, biconcave 
discs about one thirty-two hundredth of an inch in diameter. 
They are yellowish- green when seen under the microscope. 
In large masses they are red. They carry the oxygen to the 
tissues. They consist of a stroma in which is imbedded the 
hemoglobin. 

Describe the structure of the arteries. How do arteries 
exercise their function? 

The arteries have three coats — tunica intima, media and 
adventitia. The intima or internal coat consists of a lining 
of a single layer of endothelial cells and a layer of yellow 
elastic tissue. The media or middle coat is composed es- 
pecially of involuntary muscular fibers arranged transversely 
to the long axis, but it also contains many elastic fibers. The 
adventitia or outer coat is made up of a supporting layer of 
areolar tissue in which are many yellow elastic fibers. 

In the media we find many little ganglionic masses, the 
local vasomotor system. In these the vasomotor nerves end. 

The arteries exercise their function on account of being 



94 PHYSIOLOGY. 

closed tubes, by reason of their contained elastic tissue, and 
by the action of the vasomotor influence of the nervous sys- 
tem on the muscular fibers. 

Describe the fetal circulation. 

The blood coming from the placenta through the umbilical 
vein passes into the inferior vena cava, some of it passing 
first into the liver by the ductus venosus and then into the 
inferior vena cava. It is then carried into the right auricle, 
where it meets the blood returning by the superior vena cava 
from the head and upper extremities. 

The currents do not mix to any extent, but by means of the 
Eustachian valve the blood from the inferior vena cava flows 
through the foramen ovale into the left auricle, where it 
meets the small amount of blood coming from the lungs and 
is passed on into the left ventricle and out through the aorta 
to supply especially the head and arms. 

The blood from the superior vena cava passes through the 
right auricle into the right ventricle and then out through 
the pulmonary artery. Some of this blood passes to the 
lungs, but most of it passes through the ductus arteriosus into 
the descending aorta, where it mixes with the blood from the 
left ventricle and supplies the lower extremities, a portion 
passing through the umbilical arteries to the placenta. 

Mention the erectile tissues of the body and explain 
their function. 

The erectile tissues of the body are the penis, clitoris, 
nipples, and according to some, the mucous membrane of 
nose. They are concerned in the genital sense, increasing the 
sexual excitement and helping complete orgasm. 

What digestive changes take place in (a) the small in- 
testines, (b) the large intestines? 

In the small intestines proteids are changed into peptones 
and even lower bodies, as arginin and leucin; fats are split 
up, saponified and emulsified; undigested starch is changed 
into maltose, which in turn is changed into dextrose, and cane 
sugar is inverted. 



PHYSIOLOGY. 95 

In the lower part of the small intestine and in the large 
intestine microbic digestion is carried on with the forma- 
tion of putrefaction products, carbon dioxide, methane, 
hydrogen sulphide, hydrogen, indol, skatol, phenol, butyric 
acid, valerianic acid, leucin, tyrosin, trimethylamine, and 
many other products. 

Describe the structure of (a) striated muscle, (b) non= 
striated muscle. Which of these is called voluntary, and 
why? 

Striated muscle is composed of fibers transversely striated. 
Each fiber is about one inch long and one five-hundredth of 
an inch in diameter. 

The fibers consist of an outside sheath or sar oolemma, which 
is filled with a liquid, the sarcoplasm. Imbedded in this we 
find the muscle columns or sarcostyles. These are divided by 
a Kraus membrane into sarcomeres, each of which is com- 
posed of a central dark portion, the sarcous element, and on 
either side a lighter portion. 

Non-striated muscle is formed of small spindle-shaped 
nucleated cells, not transversely striated. It has some faint 
longitudinal striations. 

Striated muscle is voluntary, that is, under the -control of 
the will. 

Define reflex nervous action. Give examples. 

A reflex action is an afferent impulse followed by an ef- 
ferent impulse independent of the higher cerebral centers. 
A blow in the solar plexus causes an inhibition of the heart. 
The testicle retracts when the inner surface of thigh is stroked. 

Describe the rods and cones of the retina. 

The layer of rods and cones of the retina is the ninth and 
is separated from the choroid by the tenth or pigment layer. 
The rods are more abundant than the cones, about five to one, 
but are absent in the fovea centralis, the cones only being 
present. In the outer end of the rods the visual purple is 
found. The cones are shorter than the rods and contain 



96 PHYSIOLOGY. 

no visual purple. The optic nerve ends in these rods and 
cones, which are the active receptive organ of sight. 

Describe the sphygmograph and state its use. 

The sphygmograph or pulse recorder essentially consists of 
a spring fastened at one end, with a button on the other 
end to press on the artery, and a system of fine levers so ad- 
justed as to write the movements of the spring on strips of 
glazed, blackened paper. 

How is accommodation in the eye accomplished? 

Accommodation is accomplished by the contraction of the 
ciliary muscle relaxing the suspensory ligament and thus al- 
lowing the crystalline lens to become more convex, which it 
then does on account of its elastic capsule. 

How do veins, arteries and capillaries differ as to (a) 
structure, (b) function. 

The arteries have three coats, which contain more muscular 
and elastic tissue than the veins. The arteries have no 
valves, while many of the veins have. The capillaries are 
formed of a single layer of lance-shaped endothelial cells. 

The arteries carry the blood from the heart to the capil- 
laries. The veins carry it back to the heart. Through the 
capillary wall osmosis and diapedesis occur; thus the tissues 
are nourished and the waste matter is carried off. 

What is the function of each class of foods in the nutri= 
tive process? 

The proteids repair the tissue; the carbohydrates are the 
body fuel, being easily oxidized; the fats are not so readily 
oxidized but are used up to form heat, the excess being stored 
in the adipose tissue; the salts are necessary to keep some 
of the proteids in solution, to regulate osmosis, to neutralize 
the acid produced by katabolism, to form bone, and are a 
necessary ingredient in most of the secretions. 

State the origin and the uses of (a) lymph, (b) the bile. 

Lymph is the diluted blood plasma that has osmosed through 



PHYSIOLOGY. 97 

the capillary wall, to which is added lymphocytes formed in 
the lymphatic glands. It bathes and nourishes the tissues, 
carries away waste and adds lymphocytes to the blood. The 
products of some of the ductless glands are emptied into it. 
The bile is formed in the liver. Bile neutralizes the acid 
chyme precipitating the pepsin, aids in the emulsification and 
absorption of fats, is an antiseptic, increases peristalsis, and 
contains some waste products. 

In what manner is the heart=beat influenced by the 
pneumogastric nerve? What is the average number of 
heartbeats per minute in (a) a child aged one year, (b) 
an adult aged seventy years? 

Stimulation of the pneumogastric nerve causes a slowing 
of the heart. 

The average number of heart-beats at one year of age is 
about 115 ; at seventy years of age, about 70. 

Define emulsification, saponification. Illustrate. 

Emulsification is the breaking up of a fat into very small 
particles and holding them in suspension in a liquid in which 
they will not dissolve, as shaking together bile, water, and 
olive oil. 

Saponification is the replacing of the glycerin of a fat by 
an alkali, as the mixing of olein and sodium hydrate to form 
sodium oleate and glycerin. 

What causes an increased flow of bile into the duo= 
denum? What pathologic effects may ensue because of 
occlusion of the ductus communis choledochus? 

The act of digestion causes an increased flow of bile into 
the duodenum, as will also certain drugs, as calomel and 
podophyllin, and irritation of the intestinal mucous mem- 
brane. 

Occlusion of the ductus communis choledochus is followed 

by jaundice with its tendency to malaise, headaches, anaemia 

and slowing of the heart's action. It also interferes with the 

digestion and absorption of fats, allows of an excess of putre- 

7 



98 PHYSIOLOGY. 

f active substances being formed in the intestines, and also 
causes constipation. 

State the function of the third cranial nerve. What i& 
the effect of division of the third cranial nerve? 

The third nerve is the motor nerve for the internal rectus,, 
superior rectus, inferior rectus, inferior oblique, levator palpe- 
brarum, ciliary muscle and the constrictor of the pupil. Sec- 
tion of this nerve causes loss of accommodation, ptosis, ex- 
ternal or divergent squint and diplopia. 

What are the movements of the eyeball? Mention the 
muscles concerned in each of the movements. 

Protrusion — caused by the muscular fibers in the capsule 
of Tenon. 

Retraction — caused by the tight closing of the lids or para- 
lysis of the muscular fibers in the capsule of Tenon. 

Upward movement — caused by contraction of superior rec- 
tus and inferior oblique. 

Downward movement — caused by contraction of inferior 
rectus and superior oblique. 

Inward movement — caused by contraction of internal 
rectus. 

Outward movement — caused by contraction of external 
rectus. 

Rotary movement — caused by contraction of either of the 
two oblique muscles. 

What are the accepted theories as to the origin of (a) 
the red blood corpuscles, (b) the white corpuscles? 

The red corpuscles are formed in the red marrow of bones 
and in the spleen. 

The white corpuscles are formed in the lymphatic system, 
the spleen and the marrow of bones. 

How is the diaphragm affected in expiration? State 
cause. 

The central tendon of the diaphragm is drawn upward into- 



PHYSIOLOGY. 99 

the thorax during expiration by elastic recoil of the lungs, 
tending to produce a vacuum in the pleural cavity. 

Define secretion, excretion, protoplasm, assimilation. 

A secretion is that product of glandular activity needed 
in the various processes of the living organism. 

An excretion is that product of glandular activity con- 
taining waste of no further use to the organism. 

Protoplasm is the living substance surrounding a specially 
formed element called the nucleus. 

Assimilation is the conversion into protoplasm of nutrient 
material or food ingested. 

What are the causes of the apex beat of the heart? 

The apex being free it is brought forward to strike against 
the chest wall by the contraction of the ventricle. The shock 
of the contracting muscle also contributes to it. 

What special use does each of the following serve in the 
body after ingestion: proteids, fats, carbohydrates, alco= 
hoi, tea, and coffee? 

Proteids repair the tissues, fats are used for body fuel and 
as a reserve, carbohydrates are the body fuel, alcohol in 
small doses is a general stimulant and by irritating the 
mucous membrane causes an increased flow of gastric juice. 
Tea and coffee are stimulants, increasing the flow of the 
various secretions and stimulating peristalsis. 

State the functions of the fifth cranial nerve. 

The fifth nerve is the sensory nerve of the face, mouth 
and nasal cavities, and the motor nerve of the muscles of 
mastication. 

What effect, if any, results from the division of (a) a 
vasoconstrictor nerve, (b) a vasodilator nerve? 

Division of a vasoconstrictor nerve causes a vasodilation 
in the part it supplies. 

Division of a vasodilator nerve usually has no effect. If 
it be in action at the time, a vasoconstriction would follow. 



100 PHYSIOLOGY. 

Describe the vermicular movement of the stomach and 
intestines. What purpose does this movement serve? 

The movement of the stomach causes the food there to be 
thoroughly mixed, the peculiar contraction causing a current 
down along the fundus to the pylorus and back again along 
the lesser curvature. 

The movement of the intestine is a true peristaltic one, that 
is, one segment of the intestinal walls contracts after the 
preceding segments ; thus a wave of contraction passes down, 
mixing and pressing the food on downward. 

Differentiate white fibrous tissue and yellow elastic 
tissue as to (a) structure, (b) distribution. 

White fibrous tissue consists of white fibers arranged in 
parallel bundles, the connective tissue cells also being ar- 
ranged in this way. Yellow elastic tissue is a connective 
tissue in which the yellow fibers predominate. These fibers 
are larger than the white and are bound together with areolar 
tissue. The white fibrous tissue is found where strength and 
inelasticity is needed, as in the ligaments and tendons. 

The yellow fibrous tissue is found where elasticity is 
needed, as in the coats of the blood vessels, in the lungs, and 
vocal cords. 

Explain the action of the anospinal center in defecation. 

The anospinal center is the reflex center for defecation. 
Irritation of the mucous membrane of the rectum sends an 
impression to the anospinal center, which then causes a re- 
laxation of the sphincter muscles and an increase in peris- 
talsis. This center is under the control of the will to a great 
extent. 

How is the venous blood current maintained? What 
arteries carry venous blood? 

The venous flow is maintained by the vis a tergo, or force 
of the heart carried through the capillaries, by the play of 
the valves in the veins during muscular movements, and by 



PHYSIOLOGY. 101 

thoracic and intracardiac action. The pulmonary arteries 
carry venous blood. 

What causes the difference in pitch between male and 
female voices? What causes the voice of the youth at 
the period of puberty to " crack "? 

The male vocal cords are longer, hence the lower pitched 
voice. 

The cause of the cracking of voice at puberty is the change 
from the childish treble to the lower adult voice, causing 
now and then a treble tone to be put in. 

What is the function of connective tissue? 

The connective tissue acts as a binding, supporting, con- 
necting and protecting tissue for the more delicate tissues 
and organs. 

What is (a) an efferent nerve, (b) an afferent nerve? 
Illustrate. 

An efferent nerve is one carrying impulses from the cen- 
tral nervous system to the various parts of the body. The 
facial nerve carries motor impulses from the central nervous 
system to the muscles of expression. 

An afferent nerve is one carrying impulses to the central 
nervous system from the various parts of the body. The 
optic nerve carries impressions received on the retina to the 
brain. 

Describe the glands and villi of the intestines. 

In the intestines we find two sets of glands, B runner's 
and Lieberkuhn 's. 

The glands of Brunner are branched Convoluted tubular 
glands found dipping down in the mucous membrane of the 
duodenum only. 

The crypts of Lieberkuhn are little tubular depressions in 
the mucous membrane of both the small and large intestines. 
They are larger in the large intestine. They consist of a 
basement membrane lined with columnar and goblet-shaped 
epithelial cells. 



102 PHYSIOLOGY. 

The villi are small nipple-like projections from the mucous 
membrane of the small intestines about one-thirtieth of an 
inch long. 

A villus consists of a mass of adenoid tissue covered with 
a layer of columnar epithelium resting on a basement mem- 
brane. In the center of this adenoid tissue we find a little 
lymphatic called a lacteal. We also find in the adenoid tissue 
many capillaries which coalesce to form the venules of the 
mesenteric veins. 

Describe the movements of the blood corpuscles in the 
capillaries and explain the phenomena of diapedesis. 

The capillaries are on an average just large enough to al- 
low the red corpuscles to pass through. In passing through 
some of the capillaries they are altered somewhat in shape, 
but on account of their elastic stroma immediately resume 
their shape when the pressure is removed. As they have to 
flow along in single file at juncture of two capillaries to form 
one, they take alternate turns in passing into it. 

The white corpuscles tend to adhere to the wall and do 
not move as rapidly as the red ones. 

In diapedesis the white corpuscle pushes one of its pseu- 
dopodia through the cement substance of the cells of the 
capillary wall, and then pulls the rest of the body through 
after it. 

Mention three varieties of cells according to situation 
in the body. 

Epithelial cells are found in the skin. 

White blood corpuscles are found in the blood. 

Nerve cells are found in the central nervous system. 

What is the mode of production of heat in the body? 

Heat is produced by the chemical action going on in the 
tissues, especially in the muscular and glandular tissues. 

Describe cholesterin, giving its origin and function. 

Cholesterin is a monatomic alcohol found especially in the 



PHYSIOLOGY. 103 

nervous tissue, and thrown off in small quantities from the 
oody in bile. It is possibly a waste product of the nervous 
tissue. 

Mention and describe three varieties of cells according 
to shape. 

Involuntary muscular fibers are small spindle-shaped cells, 
containing about their center an oval nucleus. They are 
faintly longitudinally striated. 

Squamous epithelial cells are flat scale-like cells, having 
a small nucleus near their center. 

White blood corpuscles are nucleated granular masses of 
protoplasm, about one twenty-five-hundredth of an inch in 
diameter. At rest they are globular, but during ameboid 
movement are irregular in shape. 

Mention the ductless glands and give the theory as to 
the function of any one of them. 

The ductless glands are the thyroid, thymus, adrenals, 
spleen, pituitary body, coccygeal and carotid. Many other 
organs have also internal secretion. 

The adrenal secretion has a marked influence over vaso- 
motor and general muscular tone. 

How is the sensation of sound conveyed to the brain? 

It is conveyed from the cochlea by the auditory nerve to 
the medulla, then to the superior olive, through lateral fillet 
to the posterior quadrigeminal bodies to the cerebral cortex. 

What matters are excreted by the skin? How may the 
function of the skin be affected as to the amount of ex= 
cretion? 

The sweat contains one per cent, of solid matter, in which 
we find sodium chloride and other inorganic salts, urea, fatty 
acids and coloring matter. 

The function of the skin may be affected physiologically 
by increased urination and diarrhoea, by reflex irritation of 
sweat centers, by the emotions, by increase of body tempera- 



104 PHYSIOLOGY. 

ture calling for more heat dissipation, and by the accumula- 
tion of carbon dioxide in the blood. Ingestion of many drugs, 
also affects the excretion. 

Mention some of the exercises that injuriously affect 
the heart. State the reasons for your conclusion. 

Among exercises that injuriously affect the heart are 
wrestling, long-distance racing, bicycle racing and rowing 
matches, the bad effect being due to the sudden strain which 
causes dilatation and hypertrophy of the heart. 

State the function of the retina. 

The retina is the receptive nervous organ of sight. 

What are the physiologic characteristics of protoplasm? 

Protoplasm has the power of nutrition, growth, reproduc- 
tion, movement and response to stimuli. 

What is the usual difference in shape between the red 
corpuscles of the blood in the mammalia and those in 
the ovipara? 

"With the exception of the camels, mammalian red cor- 
puscles are non-nucleated, biconcave, circular discs. In the 
ovipara they are nucleated, oval and biconvex. 

State the changes in the diameter of the chest in in- 
spiration and expiration. 

In inspiration the vertical diameter is increased by the 
descent of the diaphragm; the anteroposterior and trans- 
verse diameters are increased by the raising and rotation of 
the ribs anteriorly and laterally. 

The reverse occurs during expiration. 

The circumference of the chest is increased in forced in- 
spiration from 2 to 5 or 6 inches over forced expiration. 

Explain the anatomic and physiologic difference between 
mucous, serous, and synovial membrane. 

Mucous membranes are secreting membranes lining cavities 
opening into the air and composed of one or more layers of 
epithelial cells. 



PHYSIOLOGY. 105 

Serous membranes are those lining closed sacks belonging 
to the lymphatic system and composed of a single layer of 
flat endothelial cells on a basement membrane. 

Synovial membranes are those lining closed sacks or bursas 
in joints or over tendons. They secrete synovia, which al- 
lows free motion by preventing friction. 

Describe the physical properties of healthy urine. 

Healthy urine is a straw yellow, acid, clear liquid, with 
a specific gravity of 1015 to 1025, and with a peculiar odor. 
On standing, a slight sediment collects in the lower part of 
the liquid. 

Describe the changes in form and volume, and in physi= 
cal and chemical properties, occurring in the contraction 
of a muscle. 

The muscle becomes shorter, but the volume remains the 
same. It becomes acid in reaction, more oxygen is used up 
and more carbon dioxide given off, sarcolactic acid is gen- 
erated, glycogen is used up, and the muscle substances soluble 
in water are diminished in amount, while those soluble in 
alcohol are increased. 

Locate in the brain, the seat of the special sense of 
sight, hearing and smell. 

Sight has its seat in the gyrus angularis, cuneus, and in 
the occipital lobes; hearing in the superior temporal; smell 
in the uncus. 

Explain the phenomena and causation of auditory ver= 
tigo or Meniere's disease. 

It is due to some disturbance or abnormal irritation of the 
endings of the vestibular branch of the auditory nerve. This 
branch normally sends impressions to the nucleus fasti gii in 
the cerebellum which help to control the balancing and co- 
ordination of the muscles of the body. 

How do the striped and unstriped muscular fibers differ 
in response to stimuli? 

The unstriped muscular fibers are much slower in response. 



106 PHYSIOLOGY. 

What is the order of occurrence of rigor mortis in the 
different parts of the body? 

Rigor mortis usually begins in the muscles of the eye, 
passing to the jaw and neck muscles, and in turn to the 
chest, arms, abdomen and lower extremities. 

What relation does the nervous system bear to the ex= 
cretion of perspiration? 

The nervous system through the sweat centers regulates the 
excretion of perspiration. 

What portion of the cerebrum comprises the motor area? 

The motor area is found along the fissure of Rolando in 
the ascending parietal, ascending frontal and paracentral con- 
volutions and contiguous parts of the superior frontal. 

Give the presumptions of survivorship and reasons 
therefor in the following from Casper: A is killed by a 
thrust of a saber on the head; B by that of a bayonet in 
the heart; and C by a shot which has torn open the jug- 
ular vein. 

If A's injury involved especially the base of the brain the 
shock of the injury would probably cause instant death. 

B would probably be the second to die, probably living at 
least a half hour until the giving out of the heart from 
pressure of the blood in the pericardium. 

C would be the last to die, as lacerated wounds of even 
large vessels often stop spontaneously, and his bleeding might 
be checked by pressure until surgical help arrived. 

Define the function of the mucous membrane of the 
respiratory tract. 

The mucous membrane of the respiratory tract secretes a 
protecting mucus, and because of its ciliated epithelial cells 
keeps the lungs clear of accumulation of mucus and small 
dirt particles entering in the inspired air. The vital activity 
of the squamous cells lining the air vesicles aids in the ex- 
change of the respiratory gases. 



PHYSIOLOGY. 107 

What is the composition of human milk? 

Milk contains 112 parts of solid matter to the thousand. 
Of these, sixty parts are the carbohydrate, lactose; thirty 
are fats, olein, palmitin, stearin and butyrin; twenty are 
proteids, caseinogen, lactalbumin and lacglobulin; and two 
parts are salts, especially sodium chloride and calcium phos- 
phate. 

What are the uses of perspiration? 

Through the perspiration we get rid of certain waste pro- 
ducts, supplementing somewhat the action of the kidneys. 
Through it we also throw off large quantities of heat. It also 
keeps the skin moist. 

What conditions increase the amount of solids in the 
tirine? 

Increased ingestion of salts will increase the amount of 
salts excreted. 

Diarrhoea, free perspiration and limiting the ingestion of 
fluids, will cause a relative increase of solids. Excessive 
muscular exercise will also cause a small increase in the 
-amount of solids. 

What are the functions of the pneumogastric nerve? 

Among its many functions the pneumogastric is motor and 
sensory to the larynx, motor to the pharynx and oesophagus, 
motor, sensory and secretory to the stomach, inhibitory of the 
heart, motor and sensory to the lungs, and sends some fila- 
ments through the sympathetic system to the pancreas, liver 
and intestines. 

How are the sensations of color produced? 

According to the Young-Helmholtz theory there are three 
sets of retinal fibers, each responding to the stimulation of 
one of the primary colors, green, red and violet. Stimula- 
tion of these in different degrees causes the various shades. 

According to the Hering theory there is one set of fibers, 
while there are three chemical substances found in visual 



108 PHYSIOLOGY. 

purple. The anabolism of these causes white, red and yellow - r 
katabolism, black, green and blue. Various combinations 
cause various shades. 

Describe the portal circulation; the renal circulation. 

The blood collected from the capillaries of the spleen,, 
stomach and intestines by the splenic, gastric, inferior and 
superior mesenteric veins is carried by the portal vein to 
the liver. Here this vein breaks up into smaller vessels 
running between the lobules, called the interlobular vessels. 
These break into a set of capillaries, called the lobular capil- 
laries, which coalesce to form the intralobular veins. These 
empty into the sublobular veins, which in turn form the 
hepatic vein which carries the blood into the inferior vena 
cava. The hepatic artery supplies especially the capsule of 
the liver. 

In the kidneys we find three sets of capillaries. One 
set is that of the vasa recta, short vessels given off from the 
arterial trunks and supplying the medullary portion. Then 
we have the arteries of the cortex forming the set of capil- 
laries of the glomeruli. The vessels passing out from the 
glomeruli are called the efferent vessels, and again break 
up into a set of capillaries around the convoluted portion of 
the tubules. The blood is then collected by the renal venules 
and passes out through the renal vein. 

What circumstances and conditions favor gastric diges- 
tion? 

Among the many circumstances favoring gastric digestion 
are thorough mastication, slow eating, pleasant taste to the 
food, swallowing in small mouthfuls, normal amount of con- 
diments, muscular and mental quietude, and a general healthy 
condition of the various parts of the body. 

Describe the physiology of vomiting. 

Vomiting is the spasmodic rejection of the contents of the 
stomach. It may occur from an abnormal condition of the 
vomiting center in the medulla, or reflexly from the irrita- 



PHYSIOLOGY. 109 

tion of many nerves, as the glossopharyngeal in the posterior 
surface of the larynx, or the pneumogastric in the stomach, 
or from the sight of disgusting objects, disgusting tastes or* 
smells, or from irritation of other mucous membranes, as the 
uterus. 

During the act of vomiting the diaphragm is fixed, the 
cardiac orifice of the stomach is opened by the longitudinal 
fibers and the abdominal muscles contract, causing the con- 
tents of stomach to be forced into the mouth. 

What would be the effect on digestion if the pancreatic 
duct were obstructed? 

As the pancreatic secretion acts on all classes of food, there 
would be a marked decrease in the whole digestive function, 
especially on the fats and proteids. 

Discuss bacteria in the intestines. 

The bacteria found in the intestines may be divided into 
three groups, — fermentative, chromogenic and pathogenic. 

The first class is very useful, forming peptones, dextrose 
and fatty acids, and breaking up some poisonous principles, 
as choline, into simpler bodies. Unless putrefaction becomes 
excessive, it is perfectly normal. 

Among other substances formed during microbic diges- 
tion are indol, skatol, phenol, carbon dioxide, leucin, tyrosin, 
hydrogen sulphide and ammonia. 

Give the relative activity of absorption in the alimen= 
tary canal, the skin and the lungs. 

The relative activity of absorption is first through the 
lungs, then through the alimentary canal, and third through 
the skin. 

Give the process of replacement of temporary by per- 
manent teeth. 

As the jaws grow and can accommodate the larger per- 
manent teeth, the little immature permanent teeth budded 
off from the temporary set begin to grow upward. As they 



110 PHYSIOLOGY. 

grow, the fangs of the temporary teeth are gradually ab- 
sorbed, the crown falls off, and then the permanent erupt. 

What conditions retard, suspend or prevent the coagu- 
lation of blood? 

The conditions retarding, suspending or preventing coagu- 
lation are — addition of oxalates, proteoses, peptones or leech 
extract ; low temperature ; contact with living vascular walls ; 
the covering of the surface with oil ; addition of large quan- 
tities of neutral salts; excess of carbon dioxide; death by 
lightning ; and the diseased condition, hemophilia. 

What is the function of the superior laryngeal nerves? 

The superior laryngeal nerves are the motor for the crico- 
thyroid muscles and the sensory for the larynx. 

Discuss the effect of the cooking of food as a means of 
rendering it more digestible. 

It is especially on the starchy foods that cooking has a 
good effect by breaking up the cellulose covering of the starch 
granules and forming some of the starch into dextrine. 

The fats in the cells are also liberated. 

Upon the proteids cooking has rather a detrimental effect, 
especially if the temperature is raised very high. For in- 
stance, the uncooked egg albumin is more readily digested 
than the coagulated cooked albumin. 

What agencies induce the flow of lymph to the point 
of discharge in the veins? 

The flow of lymph is induced by the vis a tergo or pressure 
in the tissues, by muscular action and the play of the numer- 
ous lymphatic valves, by muscular tissue in the lymphatic 
vessels, and by thoracic suction. 

Name some of the involuntary muscles and the function 
with which each is concerned. 

The uterus is the organ for the carrying of the developing 
embryo and foetus. The muscle is used for the expulsion of 
the foetus at the end of intra-uterine life. 



PHYSIOLOGY. Ill 

The muscular wall of the intestine is used for mixing and 
passing on downward the food received from the stomach. 

The tunica media of the arteries contains many muscular 
fibers that control the supply of blood to the various parts 
of the body. 

What do you understand by blood pressure? 

Blood pressure is the pressure to which the blood is sub- 
jected in the circulatory system. In man it is about 110 
millimeters of mercury. 

What effect does an excessive starchy diet produce? 

Et produces excessive flatulency and may lead to an ali- 
mentary glycosuria. 

Give the mechanism of the organs of hearing. 

The sound waves are converged by the auricle, pass through 
the external auditory meatus, striking then against the mem- 
brana tympani, which sets into movement the ossicles, malleus, 
incus and stapes. The base of the stapes fits into the oval 
window. Thus the sound waves cause a movement of the 
ossicles, which in turn, through the base of the stapes, cause 
vibrations to be set up in the perilymph of the vestibule ; then 
they are conveyed through the scala vestibuli and through 
the helicotrema to the perilymph of the scala tympani, and 
out through the round window to be dispersed. 

The vibration of the perilymph in the cochlea sets up 
vibration in the scala media containing the organs of Corti, 
which are the special receptive apparatus of hearing. 

The impressions received here are carried by the cochlear 
branch of the auditory nerve to the cerebrum. 

What is meant by digestion? 

The nutrient material or food ingested has to be so changed 
that it can be absorbed. This changing of the food is called 
digestion. 

What influence has the nervous system on the process 
of secretion? 

The nervous system controls the process of secretion by 



112 PHYSIOLOGY. 

the various secretory centers and nerves, and by controlling 
the amount of blood to the various organs of the body. 

Name the refracting media of the eye and the effect that 
each has on the rays of light. 

The refracting media of the eye are the cornea, aqueous 
humor, crystalline lens, and the vitreous humor. 

They all converge the rays of light, the cornea being the 
most potent, the crystalline lens coming next, then the vitreous 
and finally the aqueous humor. 

What is the location of the center for articulate speech? 

The center for articulate speech is in Broca's convolution, 
the left lower frontal in right-handed people. 

How is the sensation of pain produced? 

Stimulation of the special endings of the pain nerves in 
the skin, or stimulation of the trunk of the nerve, causes an 
impression to be sent to the special area of the brain pre- 
siding over pain sensations. When this center is so stimu- 
lated we feel pain. 

What kinds of food would you recommend in cases of 
obesity? 

The whole diet including water should be restricted and 
the relative amount of proteids greatly increased in cases 
of obesity. 

Give the reactions of the following fluids and state the 
cause of the reaction in each case: blood, gastric juice 
and pancreatic juice. 

Blood is alkaline from its contained alkaline phosphates 
and carbonates. 

Gastric juice is acid from the hydrochloric acid in it. 

Pancreatic juice is alkaline from the sodium carbonate it 
contains. 

Do variations in the rate and force of respiration affect 
the heart, and if so, in what manner? 

Increase in the rate and force of respiration increases the 



PHYSIOLOGY. 113 

number and force of the heart-beats. A deep inspiration 
held for some time will reduce the rate of a rapid heart. 

Name the organs of the special senses. 

The organs of special sense are the eye, ear, upper por- 
tion of nasal cavity, the taste bulbs on the tongue, and the 
tactile end organs. 

Describe the functions of spinal nerves. 

The spinal nerves carry the afferent and efferent impulses 
of the body and of the back of head to and from the central 
nervous system. 

Among the afferent impulses we have those of pain, tem- 
perature, tactile, pressure and muscular sense. 

Among the efferent, we have the motor, trophic, secretory 
and vasomotor. 

Describe the effect of a transverse section of the spinal 
cord in the mid=dorsal region. 

A transverse dorsal section would cause paralysis of mo- 
tion and of sensation of the parts below the section, paralysis 
of bladder and rectum, and exaggerated reflexes of the legs. 

What is meant by the condition of tetanus in a muscle? 

When a muscle goes into a state of continued contraction, 
it is said to be tetanized. 

Describe the digestion in the stomach of a meal of bread 
and milk. 

The ptyalin of saliva continues for some time in the stomach 
to change the starch of the bread into maltose. The hydro- 
chloric acid also has some action on the starch. The gluten 
of the bread is changed by pepsin into gluten peptone. The 
caseinogen is changed into casein by the rennin, and then 
the pepsin changes it into casein proteose and peptone. 

The lactalbumin and globulin are also changed into pro- 
teoses and peptones. The soluble salts are dissolved and the 
fats melted. 
8 



114 PHYSIOLOGY. 

What variations of temperature are found in the differ- 
ent parts of the body? Mention the reasons for such 
variations. 

The highest temperature is found in the blood leaving the 
liver, and is due to the amount of heat formed in this large 
gland. 

The tip of the nose is said to be the coldest part of the 
body, due to its exposed position and to the thinness of its 
walls. 

The skin surface is always cooler than the internal or- 
gans, due to the radiation of the heat of the blood from the 
skin, the evaporation of sweat from the skin and the in- 
creased amount of heat produced in the internal organs. 

Describe the mechanism in the opening and closing of 
the aortic valve. 

The three leaflets of the aortic valve are placed with their 
concavity toward the aorta. During systole the pressure in 
the ventricles forces the blood past the aortic valve into the 
aorta. As the ventricle begins to dilate in diastole the pres- 
sure of the blood in the aorta tends to force the blood back 
into the ventricle. This force fills up the pockets of the 
aortic leaflets and forces their free edges together, thus 
closing the orifice. 

Define life and death. 

"Life is that obscure principle whereby organized beings 
are peculiarly endowed with certain powers and functions 
not associated with inorganic matter." 

"Death is the cessation of life." (Dorland). 

Describe the physiology of rectal feeding. 

Small quantities of food, especially if predigested, when 
placed in the rectum are readily absorbed and will sustain 
life as long as the rectum does not become so irritable as not 
to retain the food. The food should preferably be predi- 
gested, but even egg albumin can be absorbed. 



PHYSIOLOGY. 115 

Name the excretory glands of the body and the function 
of each. 

The excretory glands are the kidneys, which excrete urine ; 
the sweat glands, which excrete sweat and dissipate heat by 
sweating; and the liver, which throws off through the bile 
some waste matter. The lungs are also excretory organs, 
throwing off carbon dioxide and nitrogen. 

Describe the origin of a tear as the result of pain. 

The pain causes reflexly a stimulation of the lachrymal 
gland, causing an increased secretion. More secretion is 
poured out than can be carried off by the lachrymal canal, 
the excess pouring over the cheek as tears. 

What is the office of the columnae carneae? 

They give strength to the ventricular wall and prevent 
the aurieulo-ventricular valves from being pressed into the 
auricles. 

Describe the physiologic causes of obesity. 

The physiologic causes of obesity are overfeeding, espec- 
ially with carbohydrates, lack of proper exercise, and cer- 
tain peculiarities of the cells of an individual. 

Name some of the bodily states which lessen the alka- 
linity of the blood. 

There is a decrease of alkalinity in rheumatism, gout, mi- 
graine, and while living on a diet deficient in the alkaline 
mineral matters, or living on a proteid diet. 

What is the influence of diet on nutrition? 

For nutrition to go on properly the diet must contain the 
various classes of foods in proper proportion. Proteids and 
salts are absolutely necessary. Nothing but proteids can 
replace the used-up proteids of tissue. Salts are needed 
especially to neutralize the acids formed during proteid 
katabolism, and to form a part in the secretions, like the 
hydrochloric acid of the gastric juice. 



116 PHYSIOLOGY. 

Describe the physiologic process by which the bite of a 
venomous snake or the hypodermic injection of the virus 
causes death. 

The poison injected under the skin is carried by the 
lymphatics to the right or left subclavian vein. Having thus 
reached the general circulation, it is distributed to the vari- 
ous organs, and so perverts the function of certain ones as 
to cause death. 

Name the bile salts, and state the physiologic function 
of bile. 

The bile salts are sodium glycocholate and sodium tauro- 
cholate. 

Bile aids in the emulsification and absorption of fats, neu- 
tralizes the acid chyme precipitating the pepsin, increases 
peristalsis, is antiseptic, and contains some waste matter 
thrown off by the liver. 

Describe the offices and the characteristics of the gray 
matter of the brain. 

The gray matter of the eerebral cortex is arranged in six 
alternate gray and white layers, the most important of which 
is the deep gray layer of large pyramidal cells. 

The gray matter of the cerebrum is the center of sensa- 
tion, volition and ideation ; that is, it receives the sensations, 
sends out all voluntary impulses and is the part of the 
nervous system in which thought goes on. 

Enumerate the physiologic advantage of natural sleep 
and state at what period of life the least sleep is required. 

Natural sleep allows the fatigued nervous system to re- 
gain its tone, causes a relaxation of the vasomotor system, 
thus giving the heart a chance to rest. In fact, sleep causes 
a relaxation of all the bodily functions, thus allowing the 
tissue to recuperate and waste matter to be carried off. 

During mature adult life the body can stand the lack of 
sleep better than at any other time. 



PHYSIOLOGY. 117 

Give the function of the epiglottis. 

The epiglottis is used in vocalization, especially of the 
lower-pitched tones. 

What differences of function exist between the white 
and gray matter of the encephalon? 

The gray matter is composed of cells, which are the ter- 
minals that receive sensations, classify the knowledge thus 
received and send out impulses. 

The white matter is made up of fibers that transmit the 
impulses, connecting the cells with each other and with the 
periphery. 

Describe the ileocecal function. 

The ileocecal valve is composed of -two semilunar folds 
of mucous membrane, containing the circular fibers. AVhen 
the cecum is distended this valve is closed, and thus re- 
gurgitation into the small intestine is prevented. 

State the approximate time of eruption of the tempo- 
rary teeth. 

The lower central incisors erupt about the 5th or 6th 
month, followed rapidly by the other six incisors. About 
the 11th or 12th month the first molars appear. Prom the 
18th to 20th month the canines erupt, followed from the 
24th to 30th month by the second molars. 

State what are, under normal conditions, the (a) adult 
number of respirations per minute; (b) body tempera- 
ture; (c) average respiratory capacity. 

Respiratory rate is eighteen per minute; the body tem- 
perature is 98.4° Fahr. ; the average respiratory capacity is 
230 cubic inches. 

Name two circumstances influencing secretion. 

Among circumstances influencing secretion are the supply 
of blood to the gland and the proper action of the normal 
reflex excitants. 



118 PHYSIOLOGY. 

What is the function of (a) sudoriferous glands; (b) 
the sebaceous glands? 

The function of the sudoriferous glands is to excrete 
sweat ; that of the sebaceous glands to secrete sebum. 

Name the principal centers of organic function in the 
medulla oblongata. 

The principal centers in the medulla are the respiratory, 
cardio-inhibitory, cardio-accelerator, vasomotor, salivation, 
mastication, deglutition, vomiting and diabetic. 

Account for the contraction and dilatation of the pupil. 

The contraction and dilatation of the pupil is a reflex 
phenomenon regulating the amount of light and sharpening 
the image for near objects. 

There are two sets of muscular fibers in the iris — circular or 
contracting and radiating or dilating. 

Give the composition of normal feces. 

The feces contain 70 to 80% of water. Of the solid mat- 
ter there are indigestible substances as cellulose, mucin and 
keratin; some undigested matter as uncooked starch and 
elastin; products of microbic digestion as indol, skatol,. 
phenol, fatty acids and leucin; bacteria; cholesterin; color- 
ing matters, stercobilin; and intestinal debris as cells and 
mucus. They are alkaline in reaction, quantity, 6 to 8 ounces 
in 24 hours. 

Describe the disturbances of function produced by the 
excessive imbibition of alcohol. 

Excessive imbibition of alcohol causes congestion of the 
stomach with altered gastric secretion, precipitation of pepsin 
during gastric digestion, congestion of liver and finally de- 
struction of many of the liver cells. On entering the cir- 
culation it acts as an irritant to the whole vascular system 
and to the kidneys. It also causes subnormal temperature. 

How are cells connected? 

Cells are connected by the intercellular substances. 



PHYSIOLOGY. 119 

Give the relative food value and ease of digestion of 
meat, milk, eggs, leguminous fruits. 

According to relative food value the order is — meat, eggs, 
milk and leguminous fruits. 

According to relative ease of digestion the order is milk, 
eggs, meat and leguminous fruits. 

What are the effects of removal of the cerebrum in the 
lower animals? 

A decerebrated animal loses all power of voluntary move- 
ment, remaining quiescent until some external stimulus brings 
out a reflex movement. Thus, food may be placed before 
him, but he will not take it; if it is placed in his mouth, he 
will swallow it. If turned on his back, he will right him- 
self. He shows no fear. 

What conditions are necessary for properly exercising 
the sense of smell? 

For the proper exercise of the sense of smell, the sub-* 
stance must be volatile, the air in the nasal cavity must be 
in motion, and the olfactory apparatus must be in normal 
condition. 

How would digestion be affected were the ductus com= 
munis choledochus obstructed? 

In obstruction of the ductus communis choledochus the 
feces contain large quantities of undigested fats, the stools 
become hard and fetid, and finally death ensues from ab- 
sorption of putrefactive products from the intestines. 

Give the mechanism of the diaphragm in (a) respiration, 
(b) hiccough. 

During rest or relaxation the diaphragm is domed upward. 
During inspiration, the muscle contracts, the central tendon is 
pulled down and thus the vertical diameter of the thorax is 
increased. During expiration, the muscle relaxes and the 
diaphragm resumes its domed position. 

Hiccough is caused by a sudden spasmodic contraction of 



120 PHYSIOLOGY. 

the diaphragm, the inspiration thus caused being arrested 
by a sudden closure of the glottis. 

How does the nervous system influence gastric diges« 
tion? 

Through the vagi the secretion of the stomach is con- 
trolled from the central nervous system. The vasomotor 
nerves of the stomach also influence secretion by controlling 
the amount of blood to the stomach. 

Give the physiology of (a) hunger, (b) thirst. 

Hunger is the constitutional need of the body for food 
with the eccentric symptoms in the epigastrium. The im- 
poverishment and changes in the blood so affect the central 
nervous system as to cause the sensation. 

Thirst is the constitutional need of the body for water 
with the eccentric symptom in the pharynx. The lack of 
water in the blood so affects the nervous system as to cause 
'this dryness of the throat. 

Give the foramen of exit, the distribution and the func- 
tion of the pathetic (fourth cranial) nerve. 

The pathetic or trochlear nerve passes out through the 
sphenoidal fissure and is the motor nerve of the superior 
oblique. 

Give the process of development of the parietal bone. 

The parietal bone is formed between membranes and is not 
preceded by the temporary cartilage. 

The membrane is formed of an external fibrous layer and 
an internal layer, which becomes the periosteum and consists 
of a layer of osteoblasts. 

Starting from a point called the center of ossification, little 
spicules of bone are deposited in all directions in the inter- 
cellular substances. As they become more numerous, they 
completely enclose the osteoblasts, which remain permanently 
in the bone. This process spreads in all directions and thus 
the bone is formed. 



PHYSIOLOGY. 121 

What changes take place in the composition of blood as 
it passes through the kidneys? 

During the passage of the blood through the kidneys, these 
organs pick out of it large quantities of urea, uric acid, 
sodium chloride, alkaline and earthy phosphates, sodium and 
potassium sulphates, indican, extractives and water. The 
blood also becomes venous, losing oxygen and adding more 
carbon dioxide. 

How are the vocal sounds produced? 

The vocal sounds are produced by vibrations of the vocal 
cords, modified in the case of vowels by peculiarities in the 
shape of the resonating cavities above, mouth, pharynx and 
nasal cavities. In the case of consonants the vibrations are 
modified by a more or less complete interference with the 
outgoing flow of air. 

What would be the effect on the saliva and on digestion 
if Stenson's duct should be divided? 

If Stenson's duct should be divided, the other parotid 
would probably hypertrophy somewhat to make up for the 
loss of secretion. There would be comparatively little effect 
on the saliva or digestion. At first mixed saliva would possi- 
bly be less watery and the digestion of starch somewhat 
retarded. 

Describe the physiologic aspect of atavism. 

Atavism is the peculiarity of the offspring of taking on 
the characteristics of the parent. 

Certain characteristics, inherent in the ovum and spermato- 
zoon and derived from the parents, cause special develop- 
ment in the certain lines, thus causing the offspring to take 
on peculiarities of the parents. 

Give the extremes of slowness and rapidity of the heart's 
action which are consistent with physical vigor, and with 
ability to perform manual labor. 

The extremes would probably be from fifty to a hundred 



122 PHYSIOLOGY. 

beats per minute; nevertheless, no definite extremes can 
be given. 

Give the process of regeneration of uterine mucous 
membrane following pregnancy. 

Following pregnancy the mucous membrane of the uterus 
is regenerated from the epithelium of the deep glandular 
layer. Around the mouth of the glands proliferation goes on 
rapidly, the groups of new cells spreading out and finally 
coalescing with each other. About the end of the fifth week 
this new membrane is complete. All cells and shreds of 
decidual tissue not concerned undergo fatty degeneration 
and are thrown off through the lochial discharge. 

In what manner, physiologically, does a largely dis- 
tended stomach produce death? 

A largely distended stomach may cause death by interfer- 
ence with normal digestion, causing excessive fermentation 
and auto-intoxication. Or, pressure on the surrounding or- 
gans causes interference with the circulation and the func- 
tions of the organs. The venous stasis causes hypertrophy 
and dilatation of the heart, which finally gives out, death 
ensuing. 

Give the physiological properties of the facial nerve. 

The facial nerve is the motor nerve for the muscles of 
expression of the face. 

Describe hemoglobin and mention its derivatives. 

Hemoglobin is a proteid-like body, readily crystallizable and 
containing iron. It readily unites with oxygen and other 
gases and has a peculiar spectrum. On the addition of an 
acid or alkali, it is broken up into hematin and globin, a pro- 
teid of the globulin group. 

Hematin, hematoidin, hemin, hematoporphyrin and methe- 
mo globin are derivatives of hemoglobin. 

Define and give the physiologic significance of (a) dys- 
pnoea, (b) dysphagia, (c) apnoea. 

Dyspnoea, or difficult rapid breathing, is caused by a de- 
ficient supply of oxygen to the tissues. 



PHYSIOLOGY. 123 

Dysphagia, or difficult or painful deglutition, may be 
caused by obstruction in the esophagus, reflex spasm, or by 
painful affections of the pharynx. 

Apnoea, or cessation of breathing, is caused by the blood 
being overcharged with oxygen, or by a reflex inhibition of 
the respiratory center. 

What prevents digestion of the stomach by its own 
juices? 

The reason that the stomach is not digested by its own 
juices is not known, so it is said to be due to a vital act. 
Neither the alkalinity of the mucous membrane, nor the 
alkalinity of the blood will explain it. 

Give the physiology of (a) blushing, (b) pallor, (c) tear 
shedding. 

Blushing is a reflex dilatation of the bloodvessels of the 
skin. Some emotional disturbance so stimulates the vasodi- 
lator center in the medulla as to cause a vasodilatation of the 
skin vessels. 

Pallor is a reflex vasoconstriction of the bloodvessels of 
the skin. It is caused by a reflex excitation of the vaso- 
constrictor center in the medulla. 

Certain emotions so reflexly stimulate the lachrymal glands 
through the central nervous system as to cause the glands 
to secrete more fluid than can be carried off through the 
nasal duct. The excess runs over the cheeks and is called 
tears. 

What causes (a) circulation of the blood, (b) the beat* 
ing of the pulse? 

The circulation of the blood is caused by the action of the 
heart, aided by the vasomotor system. 

The beating of the pulse is caused by the transmission of 
the cardiac impulse through the elastic arterial system. 

What are the functions of the pancreas? 

The pancreas secretes the pancreatic juice. In addition 



124 PHYSIOLOGY. 

to this, it has an internal secretion, because extirpation of 
the pancreas causes diabetes. 

What substances are absorbed principally in (a) the 
stomach, (b) the duodenum? 

Alcohol, water and soluble salts are absorbed in large 
quantities by the stomach. The fats, proteids and glucose 
are absorbed in the duodenum and in the rest of the small 
intestines. 

Describe the conditions within normal physiological 
limits which increase arterial blood pressure. 

Anything that will directly or indirectly cause stimulation 
of the vasomotor center will cause an increase in arterial 
pressure. 

Among these causes we have digestion, muscular exercise, 
various emotions, as fear and joy, increased resistance in the 
capillary system, dyspnoea and asphyxia. 

Name the inorganic proximate principles that enter into 
the formation of the human body. 

The inorganic proximate principles entering into the for- 
mation of the human body are water and the various salts, 
as sodium chloride, potassium sulphate, calcium fluoride and 
magnesium phosphate. 

What do you understand by the term nutrition, and 
what processes are comprised under it? 

By nutrition is meant the taking-in of nutrient material, 
its conversion into living protoplasm, and the throwing-off 
of waste matter from the cell. 

It includes digestion, absorption, metabolism and excretion. 

What are the Wolffian bodies? When do they appear 
and into what organs do they ultimately develop? 

The Wolffian bodies are the temporary kidneys of early 
intra-uterine life, appearing about the third week. In the 
female they become the parovarium; and in the male, form 
the globus major, vas efferentia and coni vasculosi. 



PHYSIOLOGY. 125 

Name the functions of the chorda tympani, sufficiently 
detailing each to clearly define its character. 

The chorda tympani contains the vasodilator fibers, but 
no vasoconstrictor fibers, for the anterior tongue and sub- 
maxillary gland. It contains the secretory fibers to the sub- 
maxillary gland, and also the taste fibers for the anterior 
two-thirds of the tongue. 

Name the groups of food stuffs constituting the source 
of muscular energy. Designate the most important and 
state what stored product is utilized. 

Carbohydrates are the most important, but fats and pro- 
teids may be used in the production of muscular energy. 
Glycogen is the stored product that is utilized. 

State the function of the nervus opticus, and explain by 
description or diagram the distribution of the fibers com- 
posing the chiasma and the effect thereof upon vision. 

The nervus opticus is the nerve of the special sense, sight. 

At the chiasma, the inner half of each optic nerve crosses 
to the opposite side; therefore, in loss of function of one optic 
nerve from injury or pressure back of the chiasma, there is 
blindness of the temporal side of retina of the same eye and 
of the nasal side of opposite eye. Stimulation of one retina 
by light causes a reflex contraction of both pupils. 

Describe metabolism. 

Metabolism is the chemical change going on in organized 
tissue. There are two divisions — anabolism or building up, 
and katabolism or tearing down. This chemical change is 
usually a hydration, dehydration, reduction or oxidation. 

In the metabolism of proteids of the tissue, proteid food 
must be used to repair the loss. 

The carbohydrates are the substances most readily broken 
up to supply heat and energy, the fats being next in order. 
The salts are needed in the various processes, but especially 
to combine with the acids, sulphuric and phosphoric, formed 
in proteid katabolism. 



126 PHYSIOLOGY. 

What is the normal proportion of blood in the human 
body and how is it renewed after hemorrhage? 

About one-thirteenth of the body weight is blood. The 
water and other constituents of plasma are renewed from the 
ingested food. The corpuscles are renewed by the bone mar- 
row, spleen and lymphatic tissues. 

State the effects of battery currents on the normal 
human nerves. 

The f aradic current stimulates them. 

A nerve during the passage of a constant current through 
it, is said to be in a state of electrotonus. There is an in- 
crease of excitability at the negative pole or kathode, and 
decrease of excitability at the positive or anode. 






HYGIENE. 



Mention eight satisfactory disinfectants and give indi- 
cations for their use. 

Formaldehyde (1 pound of formaline for every 1000 cu. ft. 
of space), sulphur (3 pounds for every 1000 cu. ft. of space) 
or bleaching powder (3 pounds for every 5000 cu. ft. of 
space) to fumigate a room. If sulphur or bleaching powder 
are used, it is necessary to steam the room before beginning 
to fumigate. Chloride of lime to disinfect excrementitious 
matter from typhoid fever, cholera, dysentery, etc. Carbolic 
acid (5% solution) or moist heat (steam and boiling water) 
to disinfect clothing. Bichloride of mercury or permanga- 
nate of potassium and oxalic acid to disinfect the skin. 

What are the most common sources of infection in 
diphtheria? 

By direct contact with the sputum or shreds of membrane 
from the patient. By inhaling the air in the vicinity of the 
patient. By fomities, as clothing, books, drinking-cups, etc. 

What conditions are essential to a good water supply? 

Purity at its source, and adequate subsequent protection 
from contamination. 

What hygienic measures should be observed by the 
nursing woman? 

An abundant diet; avoiding overfeeding; some form of 
outdoor exercise each day; monotony of life and overwork 
should be guarded against. Warm clothing, personal clean- 
liness, abundant sleep, freedom from mental cares, fright or 
anger are necessary precautions. Each time the child is re- 

(127) 



128 HYGIENE. 

moved from the breast the nipples should be washed with 
warm water and thoroughly dried. 

What precautions should a physician observe to avoid 
carrying contagious diseases? 

A linen duster and a tightly-fitting linen cap should be 
worn by the physician in the sick-room, and be removed 
after leaving the room. Immediately after manipulating the 
patient the physician should thoroughly wash and disinfect 
his hands and face. A bath and change of clothing before 
attending other patients are advisable. 

Describe the hygiene of the mouth and teeth. 

The teeth should be cleansed after each meal and on rising 
in the morning, and foreign matter between the teeth should 
be removed. Acidity of the saliva may be counteracted by 
weak alkaline mouth washes. 

What methods would you suggest for the hygienic care 
of the skin? 

Simple foods; avoiding constipation; daily exercise in the 
open air; plenty of sleep (at least eight hours daily) ; fre- 
quent warm baths and a cold sponge bath on rising each 
morning. 

What localities should be sought or avoided by rheu= 
matic patients? 

Warm, dry, equable climate should be sought. Alkaline or 
sulphur thermal springs are recommended. Damp valleys, 
shores of rivers, sea coasts and places which are much ex- 
posed to winds and sudden changes of temperature should be 
avoided. 

Name the kinds of food and the quantity of each for the 
daily use of the normal man. 

4.5 ounces of proteids; 3.5 ounces of fats; 14 ounces of 
carbohydrates; 1 ounce of salts (Moleschott). Or 118 grains 
proteids; 56 grains fats; 500 grains carbohydrates (Vbit). 
These quantities represent dry foods. If the diet is stated 



HYGIENE. 129 

as so-called solid-food (not water-free) the above quantities 
must be doubled. 50 to 80 ounces of water in liquid form 
are also taken into the system. 

What is the object of the wet pack, and what unfavor- 
able results may occur from its use? 

The cold wet pack is used to lower temperature during 
fever. The warm wet pack is used to promote elimination 
of fluid, to relax muscular spasm, to promote sleep, and raise 
lowered vitality. 

The dangers to be guarded against are heart failure or 
fatigue, or excitement to weak patients. The cold pack may 
give the patient a nervous chill. 

Describe in detail the process of disinfection by formaI= 
dehyde (formalin). 

Make the room as near air-tight as possible by closing all 
openings and cracks before beginning the process of disin- 
fection. All mattresses, pillows, clothing, books, etc., should 
be exposed as fully as possible to the action of the disin- 
fectant. Place one pound of formalin for every 1000 cu. ft. 
of air space in a "Novy" generator. Start the rapid vola- 
tilizing of the formaldehyde and allow the room to remain 
closed for one day. 

What hygienic means should be employed by persons 
prone to " catch cold "? 

A cold sponge bath followed by brisk rubbing on arising 
in the morning; daily muscular exercise in the open air and 
a liberal (but not excessive) diet, largely of carbohydrates. 

Describe the necessary sanitary precautions during the 
prevalence of an epidemic of Asiatic cholera. 

Isolate all patients and attendants ; observe strict quarantine 
of all infected houses or districts; disinfect and remove any 
accumulations of filth, excreta, etc. ; cremate those who have 
died from this disease. The water supply should be guarded 
to prevent its contamination; and insist upon householders 
9 



130 HYGIENE. 

boiling all water or milk before using the same. All gastric 
or intestinal diseases should be attended to at once. Restrict 
or prohibit the use of all fruits or uncooked foods from the 
district; and use all disinfectant precautions where cases 
exist, during continuance of case, and after its termination. 

What are the sanitary requirements of house plumbing? 

All pipes and connections, traps, etc., should be in view or 
easy of access. Each house must be directly connected by 
pipe with the common sewer. The pipes in the house must 
be of iron with leaded joints or screwed couplings. The 
drainage pipes should be laid with a gradient of at least one 
inch fall to every four feet of length; the main house drain 
must be provided with a trap after it has been carried beyond 
all house connecting pipes. Pipes from water-closet fixtures, 
bath-tubs, wash-basins and sinks must have traps close to 
each fixture. Soil pipes must extend open for at least two 
feet above the roof and air must be admitted to the main trap 
upon its house-side. 

Describe a simple form of ventilating the sick=room. 

Place a wooden strip about three inches wide and as long 
as the window frame under the lower sash; through the 
space between the top of the lower sash and the bottom of the 
upper, sufficient air will enter the room without producing a 
draught. 

What precautions should be taken in schooNrooms to 
protect the sight of scholars? 

Pupils should not sit facing the windows (the light should 
come from behind or over left shoulder) ; blackboards should 
not have a glossy surface and should not be placed between 
windows. The walls of the room should be of a neutral tint. 
Text-books should be printed in clear, large type. Faulty 
posture in reading and writing should be corrected by the 
teacher. If toilet accessories are supplied, no child suffering 
with an inflammatory disease of the eyes should be permitted 



HYGIENE. 131 

the use of the general supply. Any imperfection in vision 
of a pupil should be reported to the parents. 

What are the chief sources of contamination to drink= 
ing water? 

The emptying of sewage into the stream from which the 
supply is obtained ; surface water in settled districts gaining 
entrance to the supply; sub-soil water, after passing through 
a filthy soil ; drainage from places of burial ; and water which 
has dissolved poisonous minerals. 

Describe the several methods of purifying drinking 
water. 

Sedimentation, occurring when collections of water remain 
at rest for a considerable time, removing, in part, at least, 
suspended matter. 

Sand filtration in which the water flows upon and through 
prepared beds of sand, gravel and broken stone, packed in 
separate layers, removes from it not only suspended matter, 
but also dissolved organic matter and bacteria, through the 
action of air (oxygen) in the interstices of the filter material, 
and the action of saprophytic bacteria. 

Boiling water will free it of pathogenic bacteria and tem- 
porary hardness, but such water, after boiling, should be 
aerated to fit it for use. 

What do you understand by the " dry earth system " 
as applied to excrementitious matter? 

The container under the privy seat contains the dry earth, 
and after the use of the privy fresh earth is always to be 
added to the receptacle. From time to time the contents are 
removed and buried or otherwise disposed of. 

Contrast the incubative stages of measles and scarlet 
fever. 

The stage of incubation in measles is from one to three 
weeks (average 12 days) ; in scarlet fever from one to eight 
days (average 3 days). 



132 HYGIENE. 

Mention some of the results of tobacco smoking in 
growing school boys in respect to the circulation, air 
passages, vision and mental application. 

It depresses the circulation and produces palpitation of 
the heart. It causes low grades of inflammatory processes 
in the upper air passages, catarrhal conjunctivitis, mental 
lethargy, with inability to sustained mental application. 

What habits of school children tend to produce myopia? 

Reading of small or imperfect print ; faulty positions while 
reading or writing in which the eyes are not far enough re- 
moved from the page ; reading or writing in insufficient light, 
or when fatigued. 

What should be the proper temperature for a living 
room in winter? 

72° F. for old or weak persons; 65° F. for the young and 
vigorous. 

What should be the diet of a child over two years of age? 

The food should consist principally of milk and bread, with 
rice, tapioca, some vegetables of easily digestible character, 
and sparingly of fruit, preferably cooked; but little meat 
should be allowed, and this preferably mutton. 

What hygienic precautions should be observed by a 
pregnant woman? 

Diet should be nutritious; clothing should be loose; mod- 
erate outdoor exercise should be taken each day; the marital 
relations should cease; the action of the skin should be 
stimulated by warm baths. After the sixth month the urine 
should be examined every few weeks. Constipation should 
be corrected by hygienic measures when possible. In late 
pregnancy the nipples, if necessary, may be developed by 
judicious manipulation. 

What is the most sanitary way of disposing of city 
garbage? 

Burn it, so that all. noxious vapors are also consumed. 



HYGIENE. 133 

Mention six desirable factors in the location of a resort 
for consumptives. 

Equable climate, high altitude, dry atmosphere, pure air, 
abundant sunshine and pine forests are climatic factors for 
consumptives. 

State the accepted belief in respect to the limitation of 
protection from vaccination. 

Five years, when revaccination should be attempted. Dur- 
ing a small-pox epidemic it is advisable to revaccinate all 
individuals who have not been vaccinated within two years. 

Mention some of the adulterations in preparations of 
ground coffee for sale in the shops. 

Chicory, peas, roasted cereals and legumes, date stones, 
acorns, sawdust, etc. 

What class of foods should predominate for persons 
over sixty years of age? 

Use eight-tenths the quantity of proteids that the vigorous 
adult requires; seven- tenths the quantity of carbohydrates; 
and one and two-tenths times the quantity of fats. 

Which in your judgment is to be preferred in vaccina* 
tion, animal or humanized lymph, and why? 

Animal lymph, because in its preparation greater care may 
be taken to secure its freedom from deleterious additions. 

Name some of the nuisances dangerous to health. 

Gases and dust of a poisonous or irritating nature arising 
from many manufacturing industries. Collections of stag- 
nant water, garbage and animal excreta exposed to air; leak- 
ing drains or sewers saturating the soil, or allowing the escape 
of gases. Industries giving rise to great noise or vibration 
in thickly settled communities. 

What is the best means for preventing the access of 
sewer gas in dwellings? 

Place a trap or water seal between the house drain and the 



134 HYGIENE. 

sewer and provide an air inlet pipe to open into the drain 
pipe between this trap and the house. A ventilation pipe 
should extend from the house drain to a point above the roof. 

State the ordinary death rate of each of four cities 
having respectively a population of more than fifty thou= 
sand (50,000). 

Dublin, 39.9 ; St. Petersburg, 31. ; Berlin, 17. ; Amsterdam, 
17.8 (1897). 

Name the diseases the predisposition to which is greatly 
increased by the habitual use of alcohol. 

Diseases of the heart and vascular system, the kidneys, 
brain and liver, and of the respiratory system, particularly 
pneumonia and asthma. 

Mention methods to be employed for preventing epi= 
demies of yellow fever in the tropics. 

Remove at once to high or new ground should the disease 
appear. Cremate all those who have died of the disease; 
disinfect and remove all filth and endeavor to destroy all 
mosquitoes and their larvae, and other insect pests by the 
use of petroleum, sub-soil drainage of damp places, and fill- 
ing all stagnant pools with clean dirt. 

Name four diseases that are communicable to man 
through cows' milk. 

Typhoid fever, scarlet fever, cholera and tuberculosis. 

To what is indigestion from excessive tea drinking 
attributable. State a formula for the preparation of 
good tea. 

The indigestion is caused chiefly by tannin; also by theo- 
bromin. 

Pour one pint of boiling water over a dram of the dried 
tea leaves and allow it to stand without applying further 
heat for five minutes. 



HYGIENE. 135 

Mention some of the advantages of carefully prepared 
artificial ice as compared with natural ice. 

It may be made from distilled water so as to be absolutely 
pure. It may be obtained in any size or shape and its tex- 
ture is more uniform. 

What precautions as to food and drink should be ob= 
served by those forced to work under the direct "rays of 
the sun in summer weather? 

A small quantity of readily digestible food should be eaten 
before going to work. Liquids of a non-alcoholic character 
may be used liberally, provided perspiratory function is ac- 
tively performed. Very cold drinks should be avoided. Meat 
should be largely excluded from the diet. 

A law to prevent owners of land in the narrow streets 
of New York City from erecting buildings more than 
twelve stories in height is being agitated. Give sanitary 
and hygienic reasons for and against. 

Reasons favoring tall buildings: The persons using the 
upper floors are insured uninterrupted sunshine, good light, 
a pure air, comparatively free from street dust, and free- 
dom from ground air and water. 

Reasons against : Tall buildings prevent proper ventilation 
of lower buildings, and obscure sunlight from smaller build- 
ings and the street. Fire is difficult to extinguish in tall 
buildings. Their lower floors are often damp and generally 
dark, requiring the constant use of artificial illumination. 
They are, therefore, a menace to the lives of their occupants. 

What are the best methods of ventilating dwellings, 
and what sanitary principles are involved? 

The perflating action of wind should be utilized at least 
once each day for all rooms. One of the best methods em- 
ployed is the open fireplace, provided such fireplaces be sup- 
plied with properly constructed chimney exits. In lieu of 
this plan fresh air may be admitted through ventilators, or 



136 HYGIENE. 

between the upper and lower window-sashes. The object 
sought in these devices is to admit cold air above the heads 
of the occupants of the room so that the fresh air may pass 
through the upper portions of the room and become heated 
before reaching the occupants. The usual outlet for foul air 
is the chimney flue, but when this is not present, it may be 
replace^ by an opening for the exit of air placed near the 
floor of each room. When the incoming air is not heated the 
outlet should be at the top of the room. During cold weather 
the rate of interchange of air should not be greater than 
sufficient to change the air of the room three times an hour. 
The air which enters should not have a greater velocity than 
five feet per second, or about 3.4 miles per hour. 

What hygienic precautions should be observed in the 
care of the new=born child? 

The room should be kept at a temperature of about 72° 
Fahr. and well ventilated without draught. The child should 
be thoroughly cleansed, using a neutral fat to facilitate the 
removal of all fatty or sebaceous material before washing 
with warm water and castile soap. The eyes and surround- 
ing parts should in particular be thoroughly cleansed; if 
possible, without the aid of soap. After thoroughly drying 
the infant, its navel should be properly dressed. The infant 
should then be warmly clad, kept dry and clean, and away 
from noise and strong light. 

What hygienic precautions are necessary to insure 
healthy sleep? 

A well-ventilated room, temperature about 60° F. Room 
and bed should be perfectly clean, and the covers of the bed 
not too heavy. The head of the person should be slightly 
elevated. Noise and light should be excluded from sleeping 
apartments. 

What deleterious gases accumulate in improperly ven= 
tilated sleeping rooms? 

Carbon dioxid; carbon monoxid, if rooms be heated; hy- 



HYGIENE. 137 

drogen sulphid; ammonium sulphid, and many gases of an 
organic ammoniacal character. 

Does change in climate require any change in food; if 
so, what? 

Yes. In cold climates a greater quantity of food should 
be consumed than in hot climates. Food that is productive 
of the greatest number of heat units, as fats and meats, 
should be partaken of in cold climates. In hot climates the 
diet should consist almost entirely of well- cooked vegetables 
and ripe fruits, with the avoidance of alcoholic beverages. 

What are some of the dangers of the cold bath? 

In those of feeble circulation and at the two extremes of 
life, chilling of the surface of the body leading to internal 
congestion that may result in acute inflammation, particu- 
larly of the lungs, kidneys, stomach and bowels. Shock seri- 
ously affecting the heart ; and the production of a persistently 
Lowered temperature of the body. 

What effect has ground air and water on the health? 

Ground air is always impure, being contaminated with 
bacteria, carbonic dioxid and often with more poisonous 
gases. It occasions various degrees of ill-health, varying from 
slight general malaise to one of the acute infectious diseases 
or tuberculosis. Ground water from near the surface of pol- 
luted soils may be noxious. It causes dampness of the walls 
of houses, inviting rheumatic diseases and catarrhal inflam- 
mations. 

What hygienic principles should be observed in infant= 
feeding? 

Feed the child every two hours during the day, and about 
three times during the night till several months old; then 
less frequently. If possible let the child receive its natural 
food from the mother, and in such cases take particular pains 
to see that the nipples and breasts of the mother are kept 
dry and clean between the times of nursing. If the infant 



138 HYGIENE. 

is to be given artificial feeding, the cow's milk selected must 
be from a 'healthy animal, must be diluted with water to 
give a relatively less proportion of casein, must be sweetened 
with milk sugar, and have a slight addition of fats in the 
form of cream added, when it will approach human milk in 
composition. A definite quantity of milk which should be 
warmed to the temperature of the body should be given at 
each feeding. 

Define the word " nuisance " in a broad hygienic sense. 

"Something which either actually injures, or is likely to 
injure health, and admits of a remedy either by the indi- 
vidual whose act or omission causes the nuisance, or by the 
local authority" (Wynter-Blyth). 

What should be the height, weight and chest measure 
of a typical man aged 25 years? 

Height 67.8 inches; weight 139 pounds; measurement of 
chest 34.5 inches. 

What injurious influences, if any, do cemeteries exert 
on the health of persons living in their vicinity? 

To most persons the mental effect is depressing. Water 
passing through the soil of cemeteries may contaminate the 
water supply of the neighborhood with organic material and 
micro-organisms. The constant turning of soil of cemeteries 
may set free imprisoned gases from organic decomposition, 
and lead to contamination of the surrounding air. 

What physical conditions would render the taking of a 
Turkish bath inadmissible? 

Atheromatous arteries generally, diseases of the lungs, and 
diseases of the heart. 

What gases and combination of gases are most efficient 
as disinfectants? 

Formaldehyde, Sulphur dioxid, Chlorin, Ozone. 
What care should be employed in exhumations? 

The exhumation of those dead of contagious or infectious 



HYGIENE. 139 

diseases should not be allowed. "When possible, the exhuma- 
tion should be deferred until cold weather. The presence of 
all persons except those absolutely needed should be forbidden. 
As the workmen approach the coffin the earth should have 
poured upon it a strong watery solution of creolin. The 
coffin containing the remains should not be opened, but be 
placed at once in a zinc-lined box and hermetically sealed. 

What are the hygienic requirements and the physio= 
logical effects of bathing? 

The bath should be taken to obtain personal cleanliness, as 
well as for its stimulation of the peripheral circulation. 
Bathing should be postponed until at least two hours after a 
meal, and should consume only twenty minutes. Never bathe 
when very hungry, or when the body is overheated. Unless 
experience has shown that good effects accrue from a cold 
bath, secure a temperature of about 65 to 75 degrees Fahr. 
of the water. The bath should be followed by a thorough 
drying and brisk rubbing. Effects following a bath are re- 
moval of dirt and of dead epithelium from the person, stim- 
ulation of the functional activities of the skin; a general 
improvement in the circulation and increased functional ac- 
tivity of the organs of elimination. 

How much fresh air is required for normal respiration 
during. 24 hours? 

3,000 cubic feet per hour, or 72,000 cubic feet of air in 
24 hours. 

What is the best sanitary disposition of stable manure 
in large cities? 

The liquid portion of manure should be carried by prop- 
erly constructed trapped drains into the general sewer. The 
solid, dried manure, straw, etc., should be placed in well- 
covered pits, from which it could be removed at proper in- 
tervals in covered wagons, and employed in the country as 
fertilizer; or drain the liquid manure into the sewer and 
cremate the solid manure. 



140 HYGIENE. 

How may a privy in a city or country be kept while in 
use from becoming a nuisance? 

Have the privy emptied at frequent intervals. At inter- 
vals of five to seven days, pour into the privy vault milk 
of lime (about 20 grains of lime for each gallon of sewage), 
or strong solution of iron sulphate; or at frequent intervals 
add clean, dry earth to the privy contents, and provide a 
ventilating pipe extending high in the air and down into the 
privy vault. 

What explanation can be furnished for the greater prev- 
alence of diphtheria and smalI=pox in cold than in warm 
weather? 

During cold weather the houses are less perfectly venti- 
lated than in warm weather. Rooms are frequently over- 
crowded, less attention is paid to personal cleanliness and 
there are more sudden changes in temperature. Such condi- 
tions lower the vitality of the body and predispose to disease. 

What are the principal adulterations of milk? 

Addition of water and abstraction of cream; addition of 
coloring matter (annatto, caramel) ; preservatives (borax and 
boracic acid, salicylic acid, formaldehyde, chromates) ; gela- 
tine as a thickening for cream. 

What changes in food are effected by cooking? 

Parasites and germs are destroyed; the food is made more 
tender to facilitate mastication. The tough fibrous envelope 
of starch cells is softened, albumin is coagulated, the food 
is rendered more palatable, and the action of the different 
digestive fluids is aided. 

Give the sanitary dimensions of a schooI=room for fifty 
pupils. 

A room 15 feet high, 25 feet wide and 40 feet long would 
allow each pupil 300 cubic feet of space, which is the ade- 
quate amount for each child. 



HYGIENE. 141 

State the advantages of cremation over earth burial. 

Complete destruction of specific disease germs. If crema- 
tion be well performed no obnoxious gases are given to the 
air, no gases of putrefaction contaminate the air, and there 
is no danger of contaminating the water supply through 
drainage from cemeteries. 

What are the respective merits of cotton, wool and silk 
when used as underwear? 

In a variable climate wool is preferable because from a 
larger amount of air enclosed in its texture it acts as a good 
non-conductor of heat, retaining the body temperature. As 
wool is hygroscopic it readily absorbs moisture from which 
it parts slowly, so preventing surface chill of the individual 
by too rapid evaporation. Next in order to retain the heat 
of the body we rank silk, and least valuable for the retention 
of body heat is cotton. If it be our purpose to supply a cool 
garment we would of course reverse this order of arrange- 
ment. 

If a chemical analysis of water revealed the presence 
of nitrites and nitrates, would this condemn it for drinking 
purposes? If so, why? 

Yes, particularly if nitrites be present. Organic matter, 
particularly sewage, is converted first into nitrites, and these 
into nitrates through the action of bacteria in the soil. These 
salts would, therefore, indicate a former pollution of the 
water with probably some of that polluted material still in 
the water. If nitrates only are present, and it can be shown 
that the organic matter is of a vegetable origin only, the 
water need not be condemned. 

To what diseases are negroes comparatively insuscep- 
tible? In the Middle States to what diseases are negroes 
more prone than whites? 

Dysentery, yellow fever, and diseases incident to exposure 
to summer heat. Negroes are more prone than whites to 



142 HYGIENE. 

contract small-pox, diseases of the respiratory tract, fibroid 
tumors, keloid growths and venereal diseases. 

Give a medical and hygienic plan for the inspection of 
immigrants who have just arrived at a seaport. 

Examine the "Bill of Health" and clinical records of all 
cases treated during the voyage and the lists of passengers, 
crew and manifests, and, if desirable, the ship's log. Have 
crew and passengers mustered and compared with the lists, 
investigating any discrepancies and make a careful examina- 
tion of both crew and passengers. If a case of infectious 
disease has occurred during the voyage, disinfect all exposed 
baggage and freight and detain such members of the crew 
and passengers as have been exposed until the incubation 
period of the disease has passed. 

What conditions of ill health make residence in high 
altitudes dangerous? Why? 

Chronic Bright 's Disease, disease of the heart, emphysema, 
and old age. High altitudes occasion increased respiratory 
effort from the rarified condition of the atmosphere, causing 
increased heart action, and a lessened perspiratory function. 

State the physical conditions that make the practice of 
taking hot baths inadvisable. 

Acute inflammatory diseases, tuberculosis, organic diseases 
of the heart and brain, aneurism, cancer, and all diseases in 
which stimulation of the circulation is to be avoided. 

State some of the sequelae of (a) over=strain, (b) over= 
exertion, (c) over=training. 

(a) Parting of continuity of osseous, ligamentous, muscu- 
lar or blood-vessel structure leading to fractures, dislocations, 
rupture of muscles, hernia, rupture of heart muscle, disease 
of valves of heart or apoplexy. 

(b) May produce same conditions as overstrain and in 
addition cause general muscular relaxation, dyspnea, syn- 
cope, etc. 



HYGIENE. 143 

(c) Loss of appetite and of muscular power, successive 
crops of boils appear, individual loses mental power, as of 
concentration of thought, and digestive disturbances occur. 

What constitutes hard water and soft water? 

"Hardness is the capacity a water has for decomposing 
soap, and depends on the amount of salts of magnesia and 
calcium in solution." (Harrington.) 

Soft water contains little or no dissolved salts and rapidly 
forms a lather with soap. 

Mention the dangers of excessive shade about dwellings. 

Excessive shade interferes with the free movement of air, 
prevents penetration of the sun's rays, promotes dampness 
which is given off to the air by evaporation. It exerts a de- 
pressing mental action, promotes the growth of fungi and 
bacteria, and prevents the aspirating action of heat from the 
sun upon air and moisture in the soils. 

What is milk sterilization? How is it performed? 

Destruction of micro-organisms in the milk by heat. By 
continuous heating of the milk, under pressure, for two 
hours at 248° F. 

State the objections usually advanced against vaccina= 
tion as a preventive of small=pox. 

It is urged that it fails to protect from small-pox (which 
is false), that it may produce blood-poisoning, that constitu- 
tional diseases like syphilis, scrofula, etc., may be introduced 
by the vaccine virus, or in the operation. Also that tetanus 
may result, and that it is not right to deliberately inoculate 
a healthy person with the virus of vaccinia or of any disease. 

On what generally accepted theory are toxins used for 
the prevention and cure of disease? 

That their presence in the system renders the blood no 
longer able to support the lives of bacteria that occasion such 
toxins. 



144 HYGIENE. 

What infectious diseases may be due to impure drink= 
ing water? 

Typhoid fever, malarial fevers, cholera, relapsing fever, 
dysentery, parasitic diseases. 

Define humidity of the atmosphere. Why should a 
humid atmosphere cause rheumatic persons and persons 
suffering with the gout increased sensitiveness? 

The term humidity refers to vapor of water in the air. An 
increased humidity increases sensitiveness of gouty and rheu- 
matic patients by decreasing elimination from the skin of 
excretory organic matters and uric acid derivatives and thus 
leading to retention of such poisons in the system. 

What constitutes a thorough meat inspection? How 
should an inspection of milk be conducted? 

Meat should be inspected within 24 hours after the animal 
is killed. The following points are noted: The quantity of 
bone, for which 17 to 20 per cent, is to be allowed. The 
quantity and character of the fat, noting its color, consis- 
tency, and taste. Condition of the flesh. Condition of the 
marrow. Examination of the lungs, liver, kidneys for detec- 
tion of infectious disease manifestations. A microscopical 
examination of the flesh for detection of bacteria of path- 
ogenic character, trichina, tape-worm or other parasites. 
Where possible, it is well to investigate the surroundings in 
which the animal has lived and the methods employed for 
storage and refrigeration. 

An inspection of milk takes cognizance of its specific grav- 
ity, color, quantity of cream, presence of preservatives, pres- 
ence or absence of dilution, or addition of coloring matter, 
determination of total solids, of quantity and quality of ash, 
of fats, casein, lactose. The microscopical and bacteriological 
examinations are performed and finally an examination is 
made of the source, storage and distributing methods. 



HYGIENE. 145 

Discuss the theory of hereditary tendencies as applied 
to tuberculosis. 

Children born of tuberculous parents present less power to 
combat and overcome the attacks of the tubercle bacilli than 
others of more healthy parents. Some theorists claim that 
this deficiency of resistance is in part due to an inherited 
small heart, and lessened circulatory power, thus favoring 
conditions of passive congestion or slow grades of inflamma- 
tory processes. Such subjects as a rule show lessened lung 
expansion, a flattened or a wedge-shaped chest, etc. 

Describe the physiological action of alcohol. 

Small or therapeutic doses increase the pulse rate and the 
arterial pressure by directly stimulating the heart. Over- 
doses directly depress and paralyze the heart muscle Large 
doses produce decided lowering of body temperature. It is 
probable that the use of alcohol diminishes the elimination of 
C0 2 . Alcohol causes a great lessening in the excretion of the 
products of tissue waste. It is probable that alcohol in not 
•too large quantity is entirely destroyed in the body. In 
small doses alcohol acts as a cerebral stimulant, while larger 
doses greatly depress and abolish nervous activity, and check 
digestion. The habitual use of alcohol is accompanied by a 
disposition towards fatty degeneration, particularly of heart 
muscle, liver and kidneys, and an enlarged and dilated con- 
dition of the smaller blood-vessels and a degeneration of all 
nervous structures. 

Does alcohol possess a food action? On what do you 
base your answer? 

Yes. ' ' In the sense that it is destroyed in the system and 
yields force which is utilized by the organism, and is when 
in sufficient quantity a retarder of tissue change, checking 
the excretion of nitrogen" (H. C. Wood). We see this in 
its administration in typhoid and other long-continued fevers. 
Yet it is not a true food, since it also exerts toxic effects, 
which foods do not. 
10 



146 HYGIENE. 

State your views on compulsory vaccination and relate 
the safeguard that should be employed in all cases of 
vaccination. 

The unprotected individual should be vaccinated as a pro- 
tection to himself and to those with whom he comes in contact. 
The virus employed must be free from contamination, and 
the instruments used should be perfectly sterile, and the 
operation should be performed on a clean surface. The 
wound should be adequately protected from irritation by 
clothing or from pathogenic germs. 

In the pursuit of what trades is there a predisposition 
to pulmonary diseases? 

Trades carried on in over-crowded, poorly ventilated rooms, 
in damp localities. Trades that give rise to much dust, par- 
ticularly if such dust be of fine, hard particles, to which file- 
makers, stone-cutters, grinders, etc., are subjected. Such 
trades as necessitate cramped positions of the workers pre- 
venting proper lung expansion. In vocations giving rise to 
poisonous or obnoxious vapors, and also where the individual 
is exposed to sudden changes of temperature. 

Under what condition is tyrotoxicon found in milk, 
cheese and other articles? 

Where milk, cheese, ice cream, etc., undergo decomposition 
in the presence of other organic matter, as rotting wood, 
mould, etc. 

The excavation of streets in cities is frequently fol- 
lowed by the outbreak of disease, such as diphtheria, 
typhoid fever. What is the cause? 

Pathogenic bacteria lie dormant in the soil of cities, and 
when such soil is exposed to the air, it becomes dried, and 
its contained bacteria taking on an active existence are liber- 
ated and carried by the air to susceptible individuals. 

Describe the agency of the ptomaines in inducing dis- 
eases and the disorders produced by them. 

Ptomaines are alkaloidal bodies resulting from decomposi- 



HYGIENE. 147 

tion of nitrogenous substances. When absorbed into the 
blood they may give rise to fever, headache, torpor, fetid 
breath. They act like chemical poisons very soon after their 
introduction into the system. Many of them occasion dis- 
tinctive trains of symptoms. 

How long does a diphtheritic patient remain infective? 
How may it be proved that this infective period has 
ceased? 

About three weeks after local symptoms cease. Make fre- 
quent cultures of material from the affected site, and when 
such fail to show the specific germ, the patient will no longer 
be a source of infection. 

How may milk be the means of transmitting the germs 
of typhoid fever? 

Through water containing Eberth's bacillus gaining access 
to the milk, as through diluting the milk, washing milk re- 
ceptacles in polluted water. 

State the period of incubation in (a) vaccinia; (b) paro= 
titis; (c) pertussis; (d) varicella; (e) rotheln. 

(a) 3 to 7 days; (b) 14 to 22 days; (c) 2 to 8 days; (d) 
4 to 14 days; (e) 12 to 20 days. 

Mention the effects of working in phosphorus, as in the 
manufacture of phosphorus matches. How can the dan= 
gers be limited or prevented? 

Inhaling phosphorus fumes produces a form of necrosis of 
the jaw, particularly in such as have imperfect teeth. To 
avoid its development persons with sound teeth and freedom 
from abrasion of the interior of the mouth should be em- 
ployed. The work-room should be large and well ventilated, 
with special air-shaft to force the fumes away from face of 
workers, the employees should have short working hours, and 
frequently use a mouth wash and gargle of lime water or 
carbonate of sodium. Turpentine and charcoal should be 
exposed in the room. 



148 HYGIENE. 

What fruits are preferable in cases of habitual consti- 
pation? 

Apples, prunes, figs, tarmarinds, grapes and melons. 

Indicate a proper diet in the case of diabetes mellitus, 
obesity and early convalescence in typhoid fever. 

The diabetic should use only a small quantity of carbo- 
hydrate foods, with a relatively large quantity of proteid 
foods and fats. The patient suffering from obesity should 
use but little fluids or food containing much water. Food 
containing starch and sugar should be eaten sparingly, and 
alcoholic liquors and fats must be avoided entirely. He 
should eat lean meats, mutton, beef, lamb, chicken, eggs, stale 
bread or toast sparingly, tomatoes, lettuce, celery, asparagus, 
onions, ripe fruits of an acid nature but no sugar. 

In convalescence from typhoid fever the patient should use 
easily digestible food of a concentrated, nourishing character, 
of small bulk and without hard or irritating properties, as 
soups, broths, uncooked oysters, eggs, rice, wine, milk, calves' 
foot jelly, etc. 

What is the chief unsanitary condition of sea=going 
vessels? 

The presence of bilge water and a dirty hold. 
Describe the manner in which antitoxin is prepared. 

A virulent culture of the specific micro-organism, or a 
strong toxin is injected into the cellular tissue of the selected 
animal, under due precautions of aseptic operation. After 
the animal has recovered from the symptoms thus produced, 
another and stronger injection of the specific poison is given. 
Injection after injection of increasing strength is given at 
proper intervals, until the animal fails to show any further 
symptoms of the disease — after an injection. Blood is then 
taken from the jugular vein of the animal, the greatest care 
being observed to secure aseptic conditions. This blood re- 
ceived in sterilized flasks, which are then stoppered, is stored 
in refrigerators until separation of clot and serum occurs. 



HYGIENE. 149 

The serum is now tested to determine its value as antitoxin 
and then, after the addition of a very small proportion of 
carbolic acid, is placed in small vials, which are then her- 
metically sealed. Each vial has marked upon it its strength 
in normal antitoxin units in each cubic centimeter, and usually 
contains one dose. 

Mention some of the objections to curbed or driven 
wells in streets or houses with respect to the purity of 
water coming from these wells. 

The curbing rarely affords protection to the well water 
from gases and other emanations from sewers, gas-pipes, 
drains, etc., and even though a driven piped well may take 
its water from far below the surface, yet in the streets of 
cities, with the ever-present sewer and gas pipes, the soil 
becomes so saturated with deleterious material as to greatly 
endanger, through water carriage, the water from all forms 
of wells. 

From what disease may immunity be acquired in the 
case of persons who have once suffered from these dis- 
eases? How is knowledge of this fact utilized in the 
prevention of certain diseases? 

Yellow fever, small-pox, scarlet fever, measles, mumps, 
chicken-pox, pertussis, typhus fever, typhoid, cholera. 

We may prevent some of these diseases by the introduction 
into the patient's system of the particular antitoxin of the 
threatened disease. 

Describe the effect of a hot and moist climate on the 
human system, and state the class of diseases this atmos- 
phere is likely to induce. 

In hot and moist climates the inhabitants, as a rule, are 
of small stature and deficient in muscular development; of 
languid disposition and nervous temperament. The diseases 
most prevalent are those affecting the liver and gastrointes- 
tinal tract; also various forms of malarial disease and yellow 
fever. 



150 HYGIENE. 

What occupations are a menace to public health? Why? 

Those occupations that emit irritating, poisonous or nox- 
ious fumes and gases, from the vitiation of the atmosphere, 
as in fertilizing plants, chemical manufactories, bone-boiling 
establishments; also such occupations as give rise to much 
dust, especially if this be of sharp, hard character, as from 
cement-making, tool-making, in which the respiratory tract is 
subjected to irritation. 

Mention some of the objections to storage cisterns under 
ground. What are the objections to rain water as a drink? 

They often receive dust and dirt; sewer gas may gain 
entrance to the water when the "standing waste' ' or over- 
flow pipe of such a cistern is connected with the drain or 
soil pipe of a house. Storage cisterns cannot be properly 
ventilated, and are often difficult to clean. 

If the first part of the rain be collected, such water will 
contain dust, pollen, gases and other matters washed from 
the air. 

Mention some of the diseases to which artisans are 
especially liable. 

Painters, and those working in lead, copper and zinc, may 
suffer from metallic poisoning; match-makers from phos- 
phorus or sulphur poisoning; tool-makers and grinders from 
phthisis ; miners from affections of bronchi and lungs ; smelt- 
ers from arsenical poisoning. 

Give an opinion as to the sanitary effect of the different 
methods of heating houses. 

The most desirable method is by hot water heating by 
means of a complete plant with circulation of the hot water 
through radiators. Next in value to hot water heating is 
steam heating by radiators or by indirect radiation. The use 
of open fireplaces in the principal rooms is of great value in 
securing ventilation, but yields an unequal and insufficient 
supply of heat. Heating a house by hot air from basement 
heaters is efficient and gives good results, if the air supplied 



HYGIENE. 151 

to the heater for distribution is pure and the house is not 
too large. 

State average weight of feces in 24 hours in a nor- 
mal man. What proportion is made up of liquid and 
what of solid contents? 

Six ounces, 75 per cent, of which is water. 

Name eight principal carbohydrates used as food. 

Starch, glucose, saccharose, lactose, dextrin, cellulose, mal- 
tose and dextrose. 

Name the class of foods which should be given to chil- 
dren between the first and second years of age. 

We should supply foods in about the proportion of 2 parts 
proteid, 3 parts fat, 6 parts carbohydrates, the proteid food 
preferably milk. 

How do forests benefit public health? 

Forests act as wind barriers, promote humidity of the air 
from the widespread surface they offer for evaporation. 
They afford shade in summer, and aid in decreasing the rela- 
tive quantity of carbon dioxid in the air, exhaling oxygen to 
the air. 

State in a general way the maximum number of hours 
that primary pupils in the public schools should be kept 
at their tasks, and how frequently and in what manner 
such tasks may be varied and broken. 

One-half hour at a given task is sufficient, when the char- 
acter of the mental work should be changed. "When an 
hour's mental application has been enforced, then five or ten 
minutes should be given to light calisthenics. An intermis- 
sion of fifteen or twenty minutes in the open air should 
occur in the course of three hours' study. An intermission 
of two hours should then be allowed for luncheon and recrea- 
tion, at the end of which time a similar routine may be fol- 
lowed, as stated above, for two hours. 



152 HYGIENE. 

What abnormal condition of the eye is most common 
in school children? 

Myopia. 

What are some of the dangers involved in the domestic 
use of ice? 

Ice may contain pathogenic bacteria, and may, when re- 
moved from a sick-room transmit infectious disease to other 
members of the household. 

What is the expectation of life of a professional man 
in active practice at the age of 45 years? 

24.82 years. 

Define the term " quarantine;" mention the principal 
quarantinable diseases, and give the rules for determining 
the length of time each should be quarantined. 

"The adoption of restrictive measures to prevent the in- 
troduction of diseases from one country or locality into an- 
other" (Wyman). 

Quarantinable diseases include cholera, small-pox, yellow 
fever, plague, scarlet fever, diphtheria, typhus fever, relaps- 
ing fever, cerebro-spinal meningitis, leprosy. 

In eruptive fevers isolation of the patient (quarantine) is 
continued for two weeks after the eruption has disappeared 
except in the case of small-pox where quarantine lasts 30 days. 

The quarantine in diphtheritic cases does not cease until 
cultures made from the throat of the patient fail to show 
the bacillus of diphtheria. 

State the best means of disinfecting sputum. 

Sputum should be burned or be received into vessels con- 
taining strong antiseptic solutions. 

What is understood by the germ theory of disease? 
Mention all diseases whose causes are known to be spe- 
cific micro=organisms. 

The germ theory of disease contends that the exciting 
cause of each infectious or contagious disease is some specific 



HYGIENE. 153 

organism, and that these diseases are communicated only by 
the transference to and development of the particular para- 
site or germ within or upon the tissues of the infected in- 
dividual. 

Diseases due to specific micro-organisms are tuberculosis, 
diphtheria, cholera, typhoid fever, dysentery, pneumonia, 
glanders, leprosy, anthrax, erysipelas, gonorrhea, relapsing 
fever and tetanus. 

What diseases are incident to school life? How may 
these diseases be prevented? 

The infectious diseases, which should be prevented by early 
recognition and prompt removal of sick pupils. The room 
should be disinfected. Curvature of the spine should be cor- 
rected or prevented by properly constructed school furniture, 
and proper admission of light to the room. Myopia should 
be prevented by the use of clear, large print in text-books 
and corrections of improper positions in reading and writing, 
and a good supply of light admitted to the school-room to 
the left of the pupils. 

Contagious conjunctivitis, prevented by cleanliness and 
isolation of the patient. 

Chorea, prevented by removal of the afflicted and repres- 
sion of all the tendencies toward imitation. 

What is the value of preventive inoculation in cholera 
and diphtheria? 

Value in cholera not yet fixed. In diphtheria, antitoxin is 
both curative and prophylactic. 

Outline the construction of a camp hospital, especially 
providing for the care (with least danger to other patients, 
medical and surgical) of those suffering from contagious 
diseases. 

Obtain purity of internal atmosphere; abundance of pure 
air and sunlight within the building, facility of administra- 
tion and discipline. To obtain these requirements select a 
proper site of soil, not clay, and preferably on hillside, look- 



154 HYGIENE. 

ing southward if in winter; use a simple plan of building, 
a sufficient number of wards, preferably on the detached or 
pavilion plan. In wards each patient should have at least 
90 square feet of surface space, and 1,200 cubic feet of air 
space ; have provisions for burning all infected material, dis- 
charges, etc., to leeward of the hospital and at a suitable 
distance away. 

Can it be proved that the diminished death rate from 
diphtheria so generally announced is due to the use of 
diphtheria antitoxin? Give reasons. 

Yes. By comparing the death rate in hospitals treating 
the same class of patients, in the same community, during the 
same time, the one hospital using diptheritic antitoxin, the 
other depending upon other methods of combating the dis- 
ease. Where the antitoxin is used the death rate is much 
lower. 

Give the comparative nutritive value of sterilized or 
unsterilized cows' milk. 

The nutritive value of sterilized milk is less than of milk 
unsterilized. 

What evil consequences frequently result from the ex= 
cessive use of tobacco? 

Catarrhal inflammation of pharynx, tonsils and mouth. 
Nervous disorders of heart as palpitation, and insomnia also 
result. Derangements of stomach with loss of appetite, and 
impairment of vision together with paralysis of optic nerve, 
nervous tremors, and muscular twitchings may result. 

How should a patient who has been rendered uncon= 
scious by heat be treated? 

If the patient has a strong, full pulse and the face is red 
and congested, place him in a recumbent position with the 
head raised and apply ice until the high temperature falls 
to about 100 degrees Fahr. 

If the patient is pale, with a weak pulse, use stimulants, 
as ammonia, by inhalation; apply heat to the body and keep 
head, face and neck cool. 



HYGIENE. 155 

State the value of public baths to the health of a large 
city. 

They give facilities to the poor for obtaining personal clean- 
liness, exerting a protective influence over the development 
and spread of filth diseases. They encourage the young to 
learn to swim, and apply an excellent form of exercise, pro- 
moting growth and development. When properly used their 
effects are both tonic and stimulating. 

What is sewer gas? How does the inhalation of sewer 
gas in large quantities affect the system? 

Sewer gas is a mixture of a number of gases, among which 
we find carbonic acid gas, light carburetted hydrogen, nitro- 
gen, hydrogen sulphid, ammonium sulphid, with fetid organic 
matter, the volatile and semi-volatile results of animal and 
vegetable decompositions. 

Sewer gas gaining entrance to house or room may exert a 
depressing influence upon the occupants, and may occasion 
vomiting, purging, severe headache, prostration, and through 
its carriage of germs cause infectious diseases. Yet sewer 
gas per se is sometimes almost innocuous. A chronic form 
of poisoning from sewer gas gives rise to pallor, languor, 
frequent headaches, loss of appetite, diarrhoea, generally im- 
paired health and anemia. 

Is green wall=paper objectionable; if so, why? 

Yes, because its color is often due to a compound of copper 
and arsenic, which after becoming damp dries, and is rubbed 
or blown from the walls, producing acute or, more often, 
chronic forms of arsenical poisoning as well as mechanical 
irritation of fauces, conjunctiva, etc. 

Contrast the incubative stages of variola and measles. 

The incubative stage of variola is from six to seven days 
by inoculation, and from ten to fourteen days by infection. 
In measles it is from seven to ten days by inoculation and 
from seven to twenty-one days by infection. 



156 HYGIENE. 

What conditions and diseases in animals render their 
flesh unfit for food? 

"The flesh of all animals dead of internal diseases, or 
which have been killed while suffering from such diseases or 
animals killed by overdriving. The flesh of animals with 
contagious diseases that may be transmitted to man. The 
flesh of animals that have been poisoned. The flesh of ani- 
mals with severe infectious diseases, as pyaemia, etc. Flesh 
that contains parasites that may be transmitted to men. All 
putrid flesh" (Gerlach). 

Discuss detached wards versus many=storied buildings 
for a public hospital. 

Many wards in one building render the maintaining of dis- 
cipline and supervision easier. Quicker service, ease of com- 
munication, greater economy of administration are favored 
by many wards. Many-storied buildings prevent perfect iso- 
lation and ventilation, render diminished supply of sunlight, 
lead to danger, as in removal, should fire occur; so that the 
detached ward system seems preferable. 

Give a fair average death rate (a) in rural districts, (b) 
in towns of from 5,000 to 20,000, (c) in cities of over 
100,000 inhabitants. 

(a) 14, (b) 17, (c) 19 to 22 per thousand. 
Mention five preventable diseases. 

Tuberculosis, typhoid fever, cholera, yellow fever and 
malaria. 

Give the special hygiene of factories in which women 
and children are employed. 

Each child or woman should be allotted sufficient space to 
supply 3,000 cubic feet of fresh air an hour by a not greater 
air movement than that which would change the air three 
times each hour. The temperature should be kept constant 
at about 65 degrees Fahr. Means should be employed to 
quickly remove dust or offensive and dangerous gases. Per- 



HYGIENE. 157 

sonal cleanliness should be facilitated by properly equipped 
wash-rooms. The water-closet fixtures should be ample and 
of proper construction. An infirmary should be provided 
for immediate treatment of injuries and suddenly occurring 
illnesses. 

In the selection of a site for a dwelling what is the best 
sanitary soil, sub=soil and topography? 

A light, dry soil, as of gravel or sand, that contains no 
absorbed filth or sewage, with a nearly constant level of 
ground water, avoiding clay or impermeable material both in 
the soil and in the sub-soil. The location should not be in 
low-lying districts, nor in localities which from the geolog- 
ical formation act as collectors of underground water. The 
house should not be placed on the top of an elevation where 
it would be exposed to strong winds. All other conditions 
being favorable, the house should be built on the side of a 
hill so that it receives a maximum supply of air and sun- 
light, and in cold climates preferably with a southern ex- 
posure. 

What is the bubonic plague? What steps can be taken 
to limit or extinguish such a scourge? 

It is an acute contagious and infectious disease favored by 
filthy surroundings and at times occurring epidemically. It 
is due to a specific micro-organism and is characterized, 
among other symptoms, by glandular swelling terminating in 
abscess. Prevention depends upon isolation of the sick, thor- 
ough disinfection of the clothing, etc., and surroundings of 
the patient and the avoidance of overcrowding and filth, and 
the institution of rigid quarantine to prevent its dissemina- 
tion into a country. 

Name the principal adulterations of wine. 

Water, coloring agents (logwood, red beets, coal tar prod- 
ucts), flavoring agents (prunes, peaches, raisins, dates, dried 
apples), preservatives (salicylic acid, formaldehyde), glycer- 
ine, alum and decolorizing agents. 



158 HYGIENE. 

Give some of the requisites for the sanitary construc- 
tion of house foundations and cellars. 

To keep down the level of ground water subdrain if neces- 
sary to secure dryness. Coat the foundation inside and out 
with cement and provide a cement floor for the cellar. Admit 
plenty of air and sunlight into the cellar. 

What is your view concerning the propriety or neces= 
sity of inserting vaccine virus in multiple places? 

The duration of the protection from small-pox is said to 
be directly proportionate to the number and size of vaccine 
vesicles; so vaccinate in at least two different places and 
let the combined area of vesicle resultant measure over half 
an inch. 

Give the prophylaxis of the filth diseases. 

Sanitary inspection of all houses and .buildings with im- 
mediate abatement of any nuisances. Thorough cleanliness 
applied to persons, habitations and the community, and to 
houses of public use. Examination of water and food sup- 
plies, with correction of all disease-exciting causes. Sewage 
and waste removal systems to be placed in perfect operation. 
Isolation of patients sick with these diseases, and disinfection 
of rooms and property of such patients, and the establishment 
of house, municipal, state or national quarantine. Prevent 
access of flies and other insects to food and drink. 

What is the physical training for a weak heart when 
no valvular lesions exist? 

Beginning with gentle calisthenics, exercise should be taken, 
preferably in the open air, and increased gradually, such 
exercise to be supervised by a competent physician. Later 
on climbing exercises of a very gradual degree of difficulty 
may be taken. 

How many cubic feet of fresh air per hour are required 
by an adult? 

Three thousand cubic feet. 



HYGIENE. 159 

Describe the effects of a cereal diet. 

Many writers assert that, as a rule, such a diet produces a 
lessened muscular formation, with an increased fat produc- 
tion, and that it also causes a deficient production of red 
blood corpuscles, with an accompanying loss of oxidation and 
tissue removal; but it is probable that such a diet is com- 
patible with good health provided it contains enough proteids. 

What is the lowest temperature of steam heat at which 
pus cocci are destroyed? 

At 240 degrees Fahr. such organisms are killed in a few 
minutes, while at 212 degrees Fahr. it requires an exposure 
to steam of from thirty to forty minutes. 

What physical training would you recommend to a per= 
son with weak respiration? 

Calisthenic exercises without apparatus directed to increas- 
ing the extrinsic and intrinsic muscles of respiration, accom- 
panied by deep and slow breathing. This should be followed 
by a course of light, well-regulated gymnastic work, with 
dumb-bells, Indian clubs and wands. After a proper interval 
of several months progressively difficult mountain climbing, 
then running exercises, and finally general apparatus work 
in a good gymnasium under proper instruction. 

Name three tests for detecting impurities in water. 

Nessler's test for detecting and estimating ammonia. 
Nitrate of silver for detecting and estimating chlorides. 
Barium nitrate for detecting and estimating sulphates. 

What is the best sanitary plan for the disposal of 
sewage? 

Collect the sewage in large tanks and to it add lime, alum 
or iron sulphate. Compress the solid materials after their 
subsidence or precipitation and cremate them. Allow the 
liquid sewage to flow upon specially prepared filter beds 
which are subdrained, and the water flowing from these sub- 
soil pipes may then pass into a stream without great danger 
of adding poisonous material or pathogenic bacteria. 



160 HYGIENE. 

What is the temperature of tepid water, of hot water, 
of boiling water? 

Tepid water 75 to 85 degrees Fahr. 
Hot water 100 to 110 degrees Fahr. 
Boiling water 212 degrees Fahr. 

What diseases are propagated by drinking water? 
How can their spread be prevented? 

Infectious diseases, particularly cholera and typhoid fever ; 
diseases due to gastric and intestinal irritation, as forms of 
dyspepsia, diarrhoea, dysentery; diseases due to animal para- 
sites; diseases due to metallic poisons. 

Prohibit the use of water containing any dissolved metal. 
Distil the water, or boil it for at least one-half hour, thus 
purifying it. 

Describe in detail the sanitary precautions necessary in 
typhoid fever. 

Expose urine, stools, vomitus and sputum for three hours 
to the action of a solution of chlorinated lime, of the strength 
of six ounces to a gallon of water, breaking up all solid 
masses. Place all towels, napkins and bed linen in a 5 per 
cent, solution of carbolic acid until convenient to boil the 
same for half an hour. Secure continuous ventilation of the 
sick room. Boil all water and milk before allowing its use 
by the patient or members of the household. Fumigate the 
room and contents after the patient leaves it. 

What hygienic precautions should be employed about 
diphtheria? 

Isolate the patient; refuse admission to the sick-room of 
all whose presence is not necessary; attendants should ob- 
serve the greatest personal cleanliness; all secretions should 
be collected upon cloths and burned. All articles should be 
disinfected before being removed from the sick-room. Mem- 
bers of the household should be quarantined. 



HYGIENE. 161 

What principal hygienic direction should be given a 
patient suffering from tuberculosis? 

Always expectorate into or on such appliances as may, 
with their contents, be disinfected or bnrned. Avoid kissing. 

How can malarial districts be made healthy? 

Remove moisture from the locality by surface or sub-soil 
draining ; by planting trees like the eucalyptus, which require 
much water for their growth ; by preventing the development 
of the mosquito larvge, through the action of petroleum on 
water surfaces. 

Differentiate between endemic and epidemic diseases. 

An endemic disease is one constantly present in a com- 
munity. An epidemic disease is one which spreads rapidly, 
attacking many people at the same time. 

State the results to animal life of the combustion of 
fuel in a room without chimney connection or other 
ventilation. 

Carbon-monoxid poisoning, suffocation due to excessive 
quantity of carbon dioxide and diminished amount of oxygen ; 
a systematic poisoning due to breathing products which are 
the result of partial burning of excretions thrown off in ex- 
halations. 

What is the best method of disposing of the bodies of 
those who have died of yellow fever? 

Cremate such bodies. 

What is meant by natural and acquired immunity from 
disease? Give an example of each. 

By natural immunity we mean "that inherited trait from 
immune ancestors which enables an organism to resist the 
attacks of bacteria and their toxic secretions." Thus, as a 
rule, the negro race do not contract yellow fever. By ac- 
quired immunity we understand that through a previous 
attack of an infectious disease, or by inoculation with an 
attenuated virus of that disease, the blood of the person 
11 



162 HYGIENE. 

undergoes such changes as to present a non-fertile soil to the 
organism to whose presence the disease is due. Example, 
vaccination in preventing small-pox. 

What are the principal measures which you would 
employ for the prevention of the spread of infectious 
diseases? 

Isolate the patient and attendants; disinfect all substances 
removed from patient's room before their removal; establish 
the purity of water and food supplies ; disinfect the room and 
contents after patient's removal, and observe a precautionary 
quarantine. 

How would you prepare an artificial food for a new- 
born infant? 

Bender cow 's milk as alkaline as human milk. Dilute with 
water to reduce the quantity of casein to what it would be 
in maternal milk. Fat and sugar are increased by the addi- 
tion of cream and sugar of milk. To one pint of sterilized 
water 17% drachms of pure commercial sugar of milk are 
added and dissolved. This sugar water must be kept in a 
cool place and not be allowed to sour. When feeding time 
arrives two tablespoonfuls of cream, one of milk, two of lime 
water, and three of the milk-sugar water are mixed, and as 
soon as this mixture has been warmed to proper temperature 
it may be poured into a bottle and the food is ready for use. 
(Fisher.) 

What are the properties of oleomargarin compared with 
butter made in the usual way? 

Butter fat contains nearly 8% of the volatile fat; specific 
gravity never below 909.8; insoluble fatty acids form about 
88% of the weight of butter fat; melting-point of fat is 
between 86° and 94° F. ; readily and completely soluble in 
ether. 

Oleomargarin fat contains about %% of the volatile fats; 
specific gravity never above 904.5 ; insoluble fatty acids form 
about 95% of the total weight; melting-point rarely above 
82° F. ; less soluble in ether and leaves a residue. 



CHEMISTRY. 



State the conditions favorable to crystallization. 

That the molecules should be free to move, as they are when 
the substance is in fluid condition. Then melt the substance, 
or dissolve the substance; when through cooling, or evap- 
oration of solvent, we obtain the body in crystal form. The 
substance crystallizes through the action of three great forces, 
mechanical, chemical and magnetic. 

What temperature Fahrenheit is equivalent to a tem= 
perature "of 28 degrees centigrade? What temperature 
centigrade is equivalent to a temperature of 120 degrees 
Fahrenheit? 

28 degrees C. X t = 50.4 plus 32 equals 82.4 Fahr. Ans. 
120 degrees Fahrenheit minus 32 equals 88 X f equals 
48.8 C. Ans. 

Define atom, molecule. 

The atom is the smallest indivisible particle of simple 
matter that passes from one molecule to another in chemical 
interchanges. Not capable of existing alone. 

A molecule is the smallest subdivision of matter capable 
of existing alone and retaining its characteristic properties; 
it is composed of atoms. 

Give the names of two elements or radicals in each of 
the following groups: 

Univalent. Bivalent. Trivalent. Quadrivalent. 

Hydrogen, Oxygen, Boron, Carbon, 

Chlorin. Sulphate S0 4 . Aurum. Platinum. 

(163) 



164 CHEMISTRY. 

Illustrate the comparative significance of the following 
affixes: ous, ic, ite, ate. 

An oxy-acid of stable composition, or of great importance 
to arts and industries, takes the termination ic, as H 2 S0 4 
sulphuric acid. 

If an oxy-acid of the same elements contains less oxygen in 
its molecule it terminates in ous, as H 2 S0 3 sulphurous acid. 

Salts formed by replacing the hydrogen in part or wholly 
of an ic acid by a metal have their names terminating in ate, 
as ZnS0 4 zinc sulphate. 

Salts in which the hydrogen of an ous acid is replaced by 
a metal have their names ending in ite, as Na 2 S0 3 sodium 
sulphite. 

Compare ozone with oxygen as to (a) occurrence, (b) 
properties. 

(a) Ozone is only found in air under exceptional circum- 
stances, or in limited localities, and in very minute quantities. 

Oxygen occurs in all atmospheric air in the proportion of 
about 23 per cent, by weight. 

(b) Ozone is a very energetic oxidizing agent acting like 
nascent oxygen, and oxidizing substances that resist the action 
of ordinary oxygen, as silver. 

Ozone will not support respiration, acting as an irritant to 
respiratory membranes. 

Ozone supports combustion more vigorously than oxygen. 

State the characteristics of the following mineral 
waters: Chalybeate waters, bitter waters, sulfur waters, 
effervescent waters, cathartic waters. 

A chalybeate water is a mineral water containing dissolved 
salts of iron, usually basic carbonates. It has a slight tonic 
action, but may occasion intestinal and stomach derangement 
from its irritant action. 

Bitter waters may owe their bitter properties to Epsom 
or Glauber's salts, held in solution, when they exert a laxa- 
tive action ; or a natural water may be bitter from its contact 



CHEMISTRY. 165 

with vegetable substances, acquiring thereby tonic and stom- 
achic properties. 

Sulfur waters are those usually containing dissolved alka- 
line sulphides, or poly-sulphides, or H 2 S, although the name 
sulfuretted waters is of more frequent use in such cases. 
Such waters exert an alterative and often slight laxative 
effect, and have a certain use in treating diseases of the skin. 
The greater value of sulfur waters is found in their use for 
bathing, in chronic cutaneous affections, in gout, in rheuma- 
tism. 

Effervescent waters are such as are strongly charged with 
C0 2 gas. It is the escape of this gas that produces the effer- 
vescence. Such waters are useful as sedative and slightly 
stimulating beverages, as the use of plain soda water in allay- 
ing vomiting. 

Cathartic waters are such as contain cathartic or laxative 
salts in solution, as Epsom spring water, containing MgS0 4 ; 
Glauber's spring water, with Na 2 S0 4 ; Carlsbad waters, Hun- 
yadi water, Saratoga waters in general. 

Their effect is not only a cathartic or laxative one, but 
frequently they assist elimination from other channels, as 
kidneys, skin, etc. 

What is the antidote for nitric acid poisoning? 

Oxid of magnesium, commonly called calcined magnesia. 
Alkaline carbonates, soap, albumen, oils. 

Describe the preparation of iodid of potassium. Give 
the reaction. 

Saturate a strong solution of caustic potash in water with 
iodine. Evaporate to dryness, when a mixture of iodid and 
iodate of potassium is formed. Heat strongly, when the 
iodate of potassium parts with its oxygen; dissolve the re- 
sultant mass in water, when from it will crystallize, on evap- 
oration, cubes of potassium iodid. 

6KHO + 3I 2 = 5KI + KI0 3 + 3H 2 ; 

Then KI0 3 + heat = KI + 8 . 



166 CHEMISTRY. 

Describe lithium as to (a) occurrence, (b) salts com= 
monly used in medicine, (c) chemistry of its use in so= 
called rheumatic affections. 

(a) Lithium occurs principally in the mineral silicates or 
phosphates, (b) Salts used in medicine: 

Bromid of lithium LiBr Carbonate of lithium Li 2 C0 3 

Benzoate of lithium LiC 7 H 5 2 Citrate of lithium Li 3 C 6 H 5 7 

Salicylate of lithium LiC 7 H 5 3 

(c) It is stated that 25 parts of carbonate of lithium will 
dissolve one thousand parts uric acid at 100.4° Fahr., so it 
is administered in gout to diminish deposits of uric acid, and 
to dissolve uric acid calculi. 

Mention the important physical, physiologic and chem= 
ical properties of ptomains. 

Ptomains are putrefactive or cadaveric alkaloids, are pro- 
duced during putrid decomposition of animal and vegetable 
matters. They are the result of the growth of bacteria that 
produce decomposition of dead animal and vegetable tissues. 
They resemble vegetable alkaloids in many important fea- 
tures ; thus some contain no oxygen and are like volatile alka- 
loids; others contain oxygen and resemble fixed alkaloids. 
They often give tests identical with those of the alkaloids; 
thus there is a ptomain that will give same color tests as 
strychnin; another ptomain that resembles in action and 
tests, atropin, etc. Ptomains may be poisonous, when they 
are called toxins; or they may be non-poisonous. Ptomains, 
acting like bases, form salts. 

In their poisonous action, after a period of incubation of 
from two to six hours, symptoms of severe gastro-intestinal 
irritation occur, and then other symptoms follow, dependent 
upon the particular ptomain. 

What are the chemical constituents of normal urine? 
Give a test for the recognition of albumin in urine. 

Chlorides of calcium, magnesium, sodium, potassium. 
Phosphates of calcium, magnesium, sodium, potassium, ammo- 



CHEMISTRY. 167 

nium. Sulphates of sodium, potassium. Coloring matters, 
including urobilin, indican. Urea, uric acid (as urates), 
<3reatinin, creatin, hippuric acid. 

Boil the urine ; if it becomes hazy, or a coagulum forms, 
add a few drops of nitric acid, when, if the urine does not 
become perfectly transparent, albumen is present. 

State the principle underlying the use of antitoxins for 
the prevention or cure of disease. 

Antitoxins are found in the blood serum of animals that 
have recovered from an infectious disease, and when this 
serum is injected into other animals, or man, it renders, on 
its absorption, the animal immune from that disease. 

How may water be decomposed? Illustrate. 

By passing a current of galvanic electricity through water, 
when the hydrogen gas collects in bubbles at the negative 
electrode and the oxygen gas at the positive electrode ; or by 
passing steam or vaporous water through an iron pipe heated 
to redness, when the hydrogen gas issues at the distal end 
of the pipe and oxygen is retained in chemical union with 
the iron, coating the pipe with Fe 3 4 . 

Define and give examples of the three varieties of 
attraction. 

Attraction of gravitation is the force tending to draw 
masses of all kinds of matter together, as the attractive force 
exerted between sun and earth. 

Heterogeneous attraction or adhesion refers to surface 
attraction of unlike substances for each other; thus water 
adheres to wood. 

Homogeneous attraction or cohesion is the force uniting 
like substances, and operates in the interior of the mass as 
well as at the surface; thus cohesion aggregates the minute 
molecules of water into visible drops. 

How many r grams are there in a hectogram? How 
many scruples are contained in one pound? 

One hundred grams equal one hectogram. 



168 CHEMISTRY. 

Two hundred and eighty-eight (288) scruples one pound 
troy. 

What is the test for the presence of silver, of mercury? 

In solution: 

Silver yields a white precipitate with hydrochloric acid or 
soluble chlorides. This precipitate is silver chloride, and it 
dissolves in ammonium hydrate or hyposulphite of sodium. 

Mercury as mercurosum, in solution, gives a white precipi- 
tate with the same reagents, of mercurous chloride, not dis- 
solving, but turned black on addition of ammonium hydrate. 

Mercury as mercuricum, gives a red precipitate with solu- 
tion of potassium iodid, soluble in excess of either potassium 
iodid or mercuric solutions. 

How much water vapor will be formed by the union of 
500 cubic centimeters of hydrogen and 250 cubic centi- 
meters of oxygen? 

Five hundred cubic centimeters, at standard temperature 
and pressure. 

What is a graphic formula? Give five illustrations. 

A graphic formula endeavors to show the manner in which 
the atoms are joined or arranged within the molecule by a 
diagrammatic representation. 

H O 

Acetic acid. H— C— C— O— H 

I 
H 

H— O— H Water. H— S— H Hydrogen sulfid. 






N 



H 

H I 

H Ammonia. H C H Marsh gas. 

-H I 

H 



Give the atomic weight, atomic volume, molecular 
weight, molecular volume, and density of oxygen. 

Sixteen, atomic weight; 1, atomic volume; 32, molecular 



CHEMISTRY. 169 

weight; 2, molecular volume; 1.1056, specific gravity com- 
pared with air; 15.9, specific gravity, or density, compared 
with hydrogen. 

Describe the preparation of sulfur and name the oxids 
of sulfur. 

Soil in volcanic regions saturated by sulfur is called sulfur 
earth. This is heaped on masonry platforms and set on fire, 
when burning sulfur causes unburned sulfur to melt, trick- 
ling down through the mass, flowing along the masonry plat- 
form into tubs placed to receive it; on cooling the solid 
resulting is called crude sulfur, and is purified by subliming 
and allowing the vapor to enter a brick-lined chamber, in 
which it condenses in small round particles, technically called 
flowers of sulfur. 

As the heat in the chamber becomes high, sulfur vapor 
liquefies, and is then ladled into moulds, forming, on hard- 
ening, the roll brimstone of commerce. 

Sulfur di-oxid, S0 2 , gas. 

Sulfur tri-oxid, S0 3 , white crystals. 

Sulfur sesqui-oxid, S 2 3 , green solid. 

Sulfur per-oxid, S 2 7 . 

What is Marsh's test? Describe the apparatus em= 
ployed, and give the conduct of the experiment. 

Test for detection of arsenic. 

May use a glass flask stoppered, and through the stopper 
pass: 

1. A safety funnel, the lower end reaching to bottom of 
flask. 

2. An outlet tube of glass; the end passing through the 
stopper is flush with bottom of stopper, and issuing from the 
stopper it is bent at a right angle. To its far end is to be 
fitted (a) a tube bent at a right angle, lower part dipping 
into a solution of AgN0 3 . (b) A tube bent at a right angle 
so placed that the far part of the tube, drawn out to a jet 
point, shall point upwards. 



170 CHEMISTRY. 

Test : Place chemically pure zinc in flask, cover with dilute 
sulphuric acid, C. P., in such quantity as will come above 
lower end of safety funnel. 

Hydrogen gas is evolved. 

Allow gas to pass from the outlet tube, to which attach tube 
(a), the lower end of which is immersed in nitrate of silver 
solution. 

Heat the outlet tube at a point between flask and silver 
solution. 

At expiration of half hour should there be no brown or 
gray-black stain found on outlet tube where heated, or no 
precipitate (black) found in silver solution, and should no 
yellow precipitate form when to a little of silver solution is 
added ammonium hydrate, the zinc and acid used are free 
from arsenic. 

Then pour into safety funnel the solution suspected to 
contain arsenic, when, should arsenic be present, a black 
stain forms on outlet tube, a black precipitate appears in 
silver solution, and this solution yields yellow precipitate of 
arsenite of silver when to it we add ammonium hydrate. 

Now remove end piece that has been used, replacing it with 
tube (b) ; apply light, when a whitish flame appears; if much 
arsenic, a garlic odor or white halo surrounds flame. 

Hold cold white surface, as piece of porcelain, in flame; 
as it issues from jet, when brown or black stain of metallic 
character readily dissolving in solution of chlorinated lime or 
chlorinated soda, indicates positively presence of arsenic. 

What is olefiant gas? Name some of its properties. 

defiant gas, or ethylene, C 2 H 4 , heavy carburetted hydrogen. 

A colorless gas, feeble ethereal odor, density 14 compared 
with hydrogen. 

Can be liquefied, and is then used to produce low tempera- 
ture on its evaporation. Is inflammable, burning in air with 
brilliant flame. It is largely to the presence of this gas that 
illuminating gas yields light. 

Mixed with three volumes of oxygen and lit, it explodes. 



CHEMISTRY. 171 

One volume of defiant gas with two volumes of chlorine burn 
with red flame. 

What is meant by the destructive distillation of wood, 
and what are some of the principal products of such a 
process? 

Heating wood in a retort until it entirely loses its charac- 
teristics as wood, and collecting and cooling resultant vapors. 

Methyl alcohol, pyroligneous acid, creosote, carbolic acid, etc. 

Name and differentiate the three classes of sugars. 

Glucose, C 6 H 12 O c , crystallizes in white rounded masses. Its 
solutions polarize light to the right. Its crystals contain one 
molecule of water. It reduces metallic solutions, as of gold, 
silver, copper. 

Fructose or levulose, C 6 H 12 6 , occurs in fruits, crystallizes 
without presence of water, rotates light to the left, is directly 
fermentable. 

Saccharose, C 12 H 22 11 , cane sugar, obtained principally 
from sugar-cane, crystallizes in hard oblique rhombic prisms 
without water of crystallization, rotates light to left, dis- 
solves in one-third its weight of water, does not reduce alka- 
line copper solution. 

What is acetous fermentation? 

An advanced stage of the alcoholic fermentation. Brought 
about by presence of the mycodermic aceti, and it causes the 
souring of alcoholic liquors. It practically ' consists in the 
oxidation of alcohol, producing acetic acid. 

C 2 H 5 OH + 2 = C 2 H 4 2 + H 2 0. 

How are chlorides chemically recognized in urinalysis? 

By their yielding a white precipitate of chloride of silver 
on the addition of a solution of silver nitrate to the urine. 

Complete the following equation and write the name 
of each resulting compound under its formula: 

C 2 HC1 3 + NaHO = 

C 2 HC1 3 + NaHO = CHC1 3 + NaCH0 2 

Chloroform 4- sodic formate. 



172 CHEMISTRY. 

Pb(N0 3 ) 2 + K 2 Cr0 4 = 

Pb(N0 3 ) 2 + K 2 Cr0 4 = PbO0 4 + 2KN0 3 

Plumbic chromate -+- potassic nitrate. 

Describe two experiments showing the difference be= 
tween chemical and mechanical action. 

Mix 32 grains sulfur and 56 grains iron filings; a magnet 
will remove all of the iron, or bi-sulphid of carbon will dis- 
solve all of the sulfur. This mixing of sulfur and iron is a 
mechanical act, in which iron and sulfur still preserve their 
properties. Apply heat to such a mixture; a temperature 
much higher than the degree of heat applied will appear, due 
to chemical union of sulfur and iron, and a magnet will no 
longer attract iron, nor will bi-sulphid of carbon have solvent 
action. This is a chemical action resulting in formation of 
a new substance, iron sulphid, in which properties of iron 
and sulfur no longer exist. 

Dissolve sugar in water. No heat is evolved ; each drop of 
water shows characteristic sweetness of sugar; has been no 
chemical change, but a physical or mechanical one. Dissolve 
sugar in sulfuric acid, obtain black liquid containing no char- 
acteristic sweetness; sugar has entirely disappeared. This 
experiment is an illustration of chemical action. 

If potassium be thrown on water, what is the name and 
formula of the resulting compound? 

Potassium hydroxid, KOH, obtained when the water is 
evaporated to dryness. 

What are the general methods by which crystals may 
be obtained? 

Solidification by evaporation from solution. 
Solidification after fusion. 
Solidification by sublimation. 
Solidification by electrolysis upon a solution. 

Discuss arsenic and mention its properties, uses and 
compounds. 

Arsenic, As 2 3 , is the trioxid of element arsenicum. 



CHEMISTRY. 173 

Arsenicum is found combined in many ores, particularly 
those of metals, zinc, iron, nickel. 

The arsenious anhydrid, As 2 3 , is generally obtained by 
sweeping the flues of smelting works, treating ores of the 
metals mentioned. By subliming this impure arsenious anhy- 
drid we obtain the pure product. 

In the ore the element arsenicum occurs generally as a sul- 
phid (orpiment or realgar). 

Heat oxidizes it to the oxid As 2 3 , commonly called white 
arsenic. 

This substance has slightly sweetish taste, metallic then 
nauseating. It is both corrosive and poisonous. Antidote 
is freshly prepared, hydrated, sesquioxid of iron with mag- 
nesia : 

Add MgO or aqua ammonia to ferric sulphate or ferric 
chlorid solutions, and collect and wash the resulting brown 
precipitate. 

Arsenic is but slightly soluble in water, soluble in most 
acids. It sublimes unchanged, or if a reducing agent be used, 
it yields on heating the brownish-black element arsenicum. 

Arsenic is used in shot-making, 40 pounds to a ton of lead. 

Enters into formation of other metallic alloys. 

Used medicinally as an alterative tonic, in doses not exceed- 
ing 1-20 of a grain. 

Used in treating malarial cachexia. Has been used as 
caustic in certain cancer cures. 

Has large use in dentistry as a devitalizing agent. 

Useful in chronic forms of certain skin diseases. 

Preparations are arsenious acid, which is chemically the 
arsenious anhydrid. Tri-chlorid of arsenic, AsCl 3 . Bromides 
of arsenic and gold, and chlorids and iodids of these metals 
and of mercury. Fowler's solution, containing arsenite of 
potassium. 

What is an anesthetic? 

A substance used to produce partial or complete uncon- 
sciousness, and thus allay pain of operative procedures and 
produce muscular relaxation. 



174 CHEMISTRY. 

How much water would be required to yield ioo grams 
of hydrogen? 

Nine hundred grams of vapor of water would yield 100 
grams hydrogen and 800 grams oxygen. 

Compare the physical properties of chlorin, bromin, 
iodin and fluorin. 

Chlorin, a heavy green gas; bromin, a heavy dark red 
liquid ; iodin, scale-like blue-black solid ; fluorin, a light yel- 
low gas. 

All dissolve in water in varying degrees. Bromin yields 
orange-colored vapor; iodin, violet vapor. 

Define evaporation, filtration. 

Evaporation is passing of a liquid into a vapor from the 
surface of the liquid. This process takes place at all tem- 
peratures. 

Filtration is the act of passing a liquid through a mate- 
rial provided with very minute spaces or holes that allow the 
liquid to pass, retaining the solid suspended matters. 

Name the constituents of the atmosphere. Give the 
composition by weight and by volume. 

Weight. Volume. 

Oxygen 23 20.93 

Nitrogen 77 79.07 

Including about one per cent, of argon. 
Water vapor, .5 to 1. 
Carbon dioxid, .04. 
Traces of ammonia and nitric acid. 

Several rare gases, lately separated, of which but' little is 
known. 

Name bodily conditions effecting an increase in the 
elimination of urine and also those producing a decrease. 

In health urine is increased in amount where from any 
cause the perspiratory function or alvine discharges are less- 
ened, as from chill of the surface, cold bathing, etc. 

The ingestion of much fluid, as drink or watery foods. 



CHEMISTRY. 175 

In health urine is decreased from a reversal of above con- 
ditions. 

In disease urine is increased in diabetes mellitus, in chronic 
inflammation of kidneys, etc. 

Often at crisis of a severe disease, in hysteria and in other 
nervous disorders. 

In disease urine is decreased when disease is accompanied 
by high fever, in acute inflammation of kidneys, in severe 
infectious diseases. 

Name three common kinds of spirituous liquors and de= 
scribe their manufacture. 

Whisky, from grain; brandy, from grape juice; rum, from 
molasses. 

In each instance fermentation is first brought about, when 
the results of such fermentation are distilled at certain fixed 
temperatures. 

Give the chemistry of photography. 

A dry plate of glass is covered with an emulsion of silver 
bromid in gelatine. 

When exposed to light the parts upon which the light 
strikes have their silver bromid changed to a lower salt. 

The plate is then subjected to the action of a developer, as 
solution of pyrogallic acid, when the lower salt of silver 
bromid is reduced to metal silver, which is left upon the plate. 
The plate is then washed in hyposulphite of sodium solution, 
when all of the unchanged silver bromid is dissolved and 
removed, but the metal silver is not affected and still remains 
upon the plate; this forms a negative. From this negative, 
placed upon a paper prepared in much the same manner as 
the plate, the action of the sun prints the finished photograph. 

Complete the following equations and write the name 
of each resulting compound under its formula: 

Ca(HO) 2 +C0 2 = CaC0 3 + H 2 

Calcium carbonate + water. 

NaC 2 TL0 2 + NaHO =* CH 4 + Na 2 C0,, 

Marsh gas -f sodium carbonate. 



176 CHEMISTRY. 

What is meant by atomic weight? 

The atomic weight of an element refers to the ratio by 
weight which its atom bears to the atom of hydrogen. 

The atomic weight of an element is that number which 
multiplied by its specific heat yields a product of 6.4, nearly. 

Explain the difference between a solid and a liquid. 

In a solid the attraction of aggregations binds the mole- 
cules so closely together that they have no readiness of move- 
ment, so that the substance preserves a fixed form. 

A solid does not unite after the passage of a cutting im- 
plement. 

A liquid has its molecules less tightly bound together, so 
that they may flow readily. A liquid has no fixed form, save 
that of the containing vessel. A liquid reunites after its 
separation by a cutting implement. 

What is a gas? 

An air-like body difficult to liquefy. The molecules mak- 
ing up a gas are self-repellent, each molecule striving to pass 
as far from its neighbors as possible. 

What is water chemically considered? 

Water is the monoxid of hydrogen. Its composition by 
weight, 18 pounds of water contains 2 pounds of hydrogen 
and 16 pounds of oxygen. By volume two quarts of water 
vapor contain two quarts of hydrogen and one quart of 
oxygen condensed on chemical union to measure but two 
quarts in all. "Water may act as an electro-positive or basic 
body, as in its union with S0 3 , to form H 2 S0 4 . 

Water may act as an electro-negative or acidulous body, as 
in its union with K 2 0, to form 2KHO. 

Water generally acts as a neutral substance. Water exists 
in three states, solid, liquid and gaseous. It is the greatest 
of solvents, and gives form and often color to crystals. 

How would you determine the specific gravity of a 
liquid? 

Use a hydrometer: An instrument of glass, cylindrical in 



CHEMISTRY. 177 

shape, weighted below, and terminating above in an upright 
stem of glass, upon which are engraved lines indicating 
degrees. 

Place this instrument in the liquid to be examined, and 
note to which mark or degree the instrument sinks. 

This degree denotes the specific gravity of the liquid com- 
pared with w r ater. 

Of what are the common forms of urinary calculi com= 
posed? 

Uric acid, oxalate of calcium, phosphate of calcium, phos- 
phate of magnesium and calcium, urate of sodium and potas- 
sium. 

What is organic chemistry? 

The chemistry of the hydrocarbons and their derivatives, 
also including cyanogen and its compounds in the study. 

What is the purpose of litmus paper in urinalysis? 

For determining if the urine be acid, alkaline or neutral 
in reaction, also whether the acidity be marked or slight, and 
whether the alkalinity be of fixed or volatile character. 

How is excess of uric acid shown in the urine? 

By a ring of whitish color forming above the point of con- 
tact in the urine when nitric acid has been poured below the 
urine in a test-tube ; such ring disappears when gently heated. 

What effect is produced in mixing air with a blast flame 
as practiced with an ordinary blow=pipe? 

The air so dilutes the gas as to bring every particle of the 
gas in complete contact with the oxygen of the air, thus occa- 
sioning perfect and complete combustion of the gas. The air 
also directs the flame to a desired point. 

What metallic element is constantly present in the col- 
oring matter of the blood? 

Iron. 
12 



178 CHEMISTRY. 

Explain the process of combustion. 

Combustion is chemical union taking place between two or 
more substances, accompanied by the evolution of heat and 
light. 

Name the lightest of all known elements. 

Hydrogen. 

Etherion has been obtained recently from atmospheric air, 
and is estimated to be one ten-thousandth the weight of 
hydrogen. 

What is chemical affinity, and give an example? 

Chemical affinity expresses the desire for chemical union 
which substances show to certain other substances; thus it 
is this attractive power of chemical affinity that causes the 
union of chlorin with hydrogen. 

Give the symbols of antimony, silver, gold, iron and 
zinc. 

Antimony, Sb ; silver, Ag ; gold, Au ; iron, Fe ; zinc, Zn. 

How would you prepare hydrogen? 

Place zinc in a flask provided with a safety funnel, the 
lower end of which reaches to the bottom of the flask. 
Through a second opening in the stopper of the flask have 
an exit tube provided, the lower end of which enters the flask 
to but a short distance. Then pour into the flask through 
the funnel dilute sulfuric acid. Hydrogen gas is formed, 
and escapes through the exit tube. 

What acid contains chlorin as an important element? 

Hydrochloric acid, HC1 (muriatic acid). 

How does wine differ chemically from brandy? 

Wine contains from 8 per cent, to 18 per cent, of alcohol; 
brandy from 45 per cent, to 55 per cent. Wine is a product 
of fermentation of fruit juices ; brandy results from distill- 
ing the fermented product of fruit juices. Wine contains a 
number of compound volatile ethers that are not present in 
brandy. 



CHEMISTRY. 179 

What is the substance (or substances) from which ordi- 
nary alcohol is derived? 

Grain, as oats, rye, corn, all of which first undergo ger- 
mination, then fermentation, then distillation, when the ex- 
traneous matters may be separated by chemical means or by 
fractional distillation. 

What element constitutes four=fifths of the air? 

Nitrogen. 

Explain the principle of the Bunsen burner. 

The Bunsen burner is supplied near its base with aper- 
tures for the ready admission of air and its mixture with gas 
before the latter is lit. Each particle of gas is thus supplied 
with sufficient air to obtain perfect combustion. 

What is the essential element of all acids? 

Hydrogen. 

Name three elements in the potassium group. 

Potassium, sodium, lithium. 

Is sulphurous acid a solid, a liquid or a gas at ordinary 
temperature? 

It is a liquid resulting when S0 2 is dissolved in water. 

What is albumin? 

It is a proteid body composed of H, C, O, N, and S ; it is 
colloidal, and is changed in digestion into crystalizable pep- 
tone. It occurs in vegetable structures as well as in animal. 

Name the principal sources of bromin. 

Natural mineral waters containing magnesium bromid in 
solution. Sea waters. 

Give the name and formula of a compound of sulfur and 
hydrogen. 

Hydrogen sulfid, H 2 S (sulfuretted hydrogen). 



180 CHEMISTRY. 

What is the meaning of the sesqui in chemical nomen= 
clature? 

It means one and a half, and refers to one and a half times 
the volume of one element in combination with one volume 
of a second element, or it refers to one and a half times the 
atomic weight of one element in combination with once the 
atomic weight of another element; but inasmuch as we can 
have no half atoms in formulae, it is customary to preserve 
the ratio between the weights of the elements while using 
whole numbers. Example: Fe 2 3 , sesqui-oxid of iron. 

Where does potassium occur? 

Potassium always occurs combined with other elements in 
nature existing in organic salts in plants, and when such 
plants are burned the organic salts decomposing yield, in the 
ash of the plant, carbonate of potassium. 

Define and give an example of each of the following: 
(a) Binary compound, (b) acid, (c) hydrate, (d) salt. 

(a) A compound containing two elementary forms, as 
AgCl. (b) An acid is a salt of hydrogen having a sour 
taste, bleaches vegetable colors, turns litmus red, corrosive 
action, when concentrated, upon tissues, unites with and neu- 
tralizes bases, forming salts and water, as HN0 3 . (c) A hy- 
drate is a member of the water type, in which one hydrogen 
atom in a molecule of water has been replaced by a metal or 
an electro-positive radical, as KOH. (d) A salt is a sub- 
stance formed by the replacement of all or part of the hydro- 
gen of an acid by a metal, as K 2 S0 4 . 

What are the laws governing combination of elements? 

1. All chemical compounds are definite in their nature; 
the ratio of the elements forming them is constant. 

2. If one element unites with another in more than one 
proportion, such proportions will be multiples or submultiples 
of each other. 

3. The proportion by weight in which any two elements 
will unite with a third element represents that proportion in 



CHEMISTRY. 181 

which they would unite with each other if they could so 
combine. 

What is a chemical reagent? 

A substance having an active chemical effect upon other 
chemical substances. A substance which by its contact with 
another substance creates new compounds that can be appre- 
ciated by us, and thus afford a test for detecting the body to 
which the reagent has been added. 

Mention a pentad element and explain the name. 

Nitrogen. 

A pentad element is one the atom of which desires live 
monad atoms to fully satisfy the pentad atom in its desire 
for chemical union. 

Explain the terms (a) amorphous, (b) alkali, (c) water 
of crystallization, (d) nascent state. 

(a) Amorphous means powdery, non-crystalline solid, (b) 
Alkali, a body possessing the strongest of basic or electro- 
positive properties, usually referring to oxids and hydrates 
of alkaline metals or metals of the alkaline earths, (c) Water 
of crystallization is water present in solid structures pre- 
serving their geometrical form and frequently the color of 
the crystal bodies; it may be removed by heating at temper- 
atures not higher than the boiling point of water, (d) Nas- 
cent state, or newly born, refers to matter in its atomic form, 
or before the individual atoms freed from a compound have 
united to form molecules. 

What are the properties and uses of glucose? 

A white or yellowish-white, sweetish substance, freely sol- 
uble in water, possessing not quite the sweetening power of 
cane-sugar. It is obtained from starch and starch-like sub- 
stances, as cellulose. Its formula is C G H 12 G , and it can now 
be obtained in crystal form. It polarizes light towards the 
right. It converts blue cupric hydrate into red cuprous oxid 
when heated with solutions of the copper salt. It is used as 
a substitute for cane-sugar. 



182 CHEMISTRY. 

What is the difference between nitric oxid (NO) and 
air? 

Nitric oxid is a colorless gas, becoming orange-red the in- 
stant it comes in contact with air or oxygen ; it can be lique- 
fied, giving rise to a blue- colored liquid. It will not support 
combustion nor respiration. It has a fixed and definite per- 
centage composition, and is a chemical compound. Air is not 
a chemical compound, but a mechanical mixture of one part 
oxygen with four parts nitrogen. Air is colorless, not changing 
in contact with oxygen. When liquefied is without color. It 
supports combustion and animal respiration. We may sep- 
arate the oxygen and nitrogen in air with but little diffi- 
culty, but cannot so readily separate oxygen and nitrogen in 
nitric oxid. 

Give equation for the production of ammonia from am= 
monium chlorid and calcium hydroxid. 

2NH 4 C1 + Ca2HO = 2NH 3 + 2H 2 + CaCl 2 . 

How was salicylic acid originally derived? How is it 
now manufactured? What are its properties? 

It was originally obtained from oil of gaultheria. It is now 
manufactured by passing C0 2 into a heated retort containing 
sodium carbolate, C 6 H 5 ONa+C0 2 =C 6 H 4 (OH)CO.ONa, and 
decomposing this sodium salt with HC1. 

It occurs in fine white needle-shaped crystals, permanent in 
air, of sweetish taste, acid reaction, soluble in 450 parts of 
cold water, soluble in 2 parts alcohol; solution produces in- 
tense violet color with ferric salts. 

Used as food preservative, is antiseptic and antirheumatic. 

Describe the method of preparing H by the action of Na 
on H 2 0. Write the formula for the reaction and find how 
many grams of H 82 grams of Na would make by this 
process. (The atomic weight of H is 1, of O 16, of Na 23.) 

Place a piece of clean-scraped sodium in a combustion 
spoon and cover it with a cage of gauze wire to hold it in 



CHEMISTRY. 183 

place. Fill a cylindrical glass jar completely full of water 
and invert month down in the pneumatic trough. 

Plunge combustion spoon containing Na quickly under 
water, below the mouth of the glass jar; the Na at once de- 
composes water, and bubbles of hydrogen gas rise in the jar. 

Na + H 2 0==NaOH + H 

23 + 18 = 40 + 1 

23 grams of Na = 1 gram H 

23 :l::82:X = 3.565 + of H. 

Give a brief description of three experiments illustrate 
ing the properties of oxygen. 

Plunge a smouldering piece of charcoal in a jar of oxygen 
and the charcoal kindles, burning brilliantly. 

Heat a watch spring at one end until red-hot. then plunge 
into jar of oxygen, and the steel spring burns with great 
brilliancy, to change to ferric oxid. 

Place a piece of phosphorus in a test-tube, cover it with 
water, warm slightly. Now if a jet of oxygen be directed by 
a long glass tube upon the phosphorus, the latter will catch 
fire, burning below the surface of the water. 

What is the source of phenacetin? 

It is a product of the destructive distillation of coal tar. 

Give the occurrence in nature of phosphorus; of chlorin. 

Phosphorus occurs in nature as phosphate of calcium in 
the mineral apatite, and as phosphate of calcium and as phos- 
phate of magnesium in bones. It is also found as phosphin 
from rotting phosphoretted bodies. Chlorin occurs in nature 
chemically combined with metals, as NaCl, AgCl, etc. As 
NaCl it is found in sea water, river water, and in most 
natural waters, and also in mineral deposits, as rock salt, 
and in tissues and fluids of animal bodies, and in plants. 

What are the chemical names of (a) borax, (b) marble, 
(c) blue vitriol? 

(a) Sodium bi-borate, or sodium pyro-borate. (b) Cal- 
cium carbonate, (c) Copper sulphate. 



184 CHEMISTRY. 

Define positive element, negative element. Illustrate 
each. 

A positive element is one which, on the decomposition of 
a compound by electrolysis, will be found deposited upon the 
negative electrode. 

A negative element is one which, for its chemical combina- 
tions, selects an electro-positive or metal element. A negative 
element will be deposited at the positive electrode when a 
compound containing it undergoes decomposition by electro- 
lysis. 

Iron, gold and hydrogen are positive elements. Oxygen,, 
sulfur and chlorin are negative elements. 

Mention the halogens and state in what respects they 
exhibit marked similarity. 

Chlorin, bromin, iodin, fluorin, cyanogen. 

All are monads, all electro-negatives, all form simple or 
hydrogen acids. First four possess bleaching and disinfect- 
ant action. All combine with metals. Except fluorin, they 
form oxy-acids and oxy-salts. 

Mention the properties of hydrogen. 

Hydrogen is a colorless, odorless, tasteless gas. The light- 
est of the well-known elements. Practically insoluble in 
water, burns with a colorless flame, yielding more heat in its 
burning than any equal weight of any other substance. In its 
combustion in air it forms water. Mixtures of hydrogen with 
oxygen or air explode when heated. 

Hydrogen is not poisonous, but will not support combus- 
tion nor respiration. It is electro-positive. "When liquefied 
it forms a steel-blue liquid that is opaque to the passage of 
light. It is used as a standard for many scientific deter- 
minations, as, for instance, of valencies, of classification of 
elements and radicals, of specific gravities of gases and vapors. 

State (a) the normal specific gravity of urine, (b) the 



CHEMISTRY. 185 

causes of abnormal deviations in the specific gravity of 
urine. 

From 1018 to 1025. Specific gravity is lowered in poly- 
uria, as of diabetes insipidus. In chronic interstitial neph- 
ritis. In certain nervous disorders, as hysteria, chorea, etc. 

Specific gravity is above 1025 in diabetes mellitus, in acute 
inflammation of kidney, in certain crises in the course of 
chronic nephritis accompanied by partial suppression of urine. 

In certain disorders of digestion. 

In febrile affections. 

Mention the principal chemical constituents of bile. 

COMPOSITION OF BILE. 

Water 91.68 Soaps 1.39 

Mucus and pigment .129 Fat .73 

Glycocholate of sodium 3.03 Lecithin .53 

Taurocliolate of sodium .87 Cholesterine 35 

State the properties of aluminum and mention its im= 
portant salts. 

It is the lightest of metals, used for building purposes, etc. 
It has a specific gravity of 2.5. It does not oxidize in air, and 
does not tarnish. It is strong, possesses considerable malle- 
ability. Its salts of greatest use are ammonium and potas- 
sium alums. 

Give the properties of two important salts of zinc used 
medicinally. 

Zinc sulphate, ZnS0 4 , used as an astringent, in watery 
solution, for local application, as in form of sprays, injections, 
gargles, eye-washes. Internally, in doses of half drachm, is 
used as a mechanical emetic, being free from depressant effect. 
Sulpho-carbolate of zinc, in doses of from 2 to 10 grains. 
Used as an intestinal antiseptic, as in typhoid fever; also 
used in solution as an antiseptic wash. 

Give in detail two tests for ascertaining the presence of 
albumen in the urine. 

Raise the specific gravity of the urine 10 degrees by add- 



186 CHEMISTRY. 

ing sufficient saturated solution of sodium chlorid in water; 
then add a few drops of acetic acid to this mixture, and 
holding the test-tube at the bottom allow the upper layer of 
fluid to be heated to boiling in the flame of a Bunsen burner. 
If any coagulation or diminished degree of transparency 
occurs in the heated portion of the fluid, compared with the 
unheated portion, albumen is present. 

Place a 10 per cent, solution of ferrocyanide of potassium 
in a test-tube and add to it half its volume of acetic acid; 
mix well. Then run down the side of the tube the suspected 
urine so that it floats upon the reagent without mixing. If 
albumen is present there will be impairment in transparency 
of the liquids, or even an evident precipitation if much albu- 
men be present. 

Give the formula and properties of methane and de- 
scribe its preparation. 

Methane, CH 4 , is a colorless, tasteless gas. It is the light- 
est of compound gases. Its specific gravity is but half that of 
air. It is called marsh gas and light carburetted hydrogen. 
It burns readily when lighted in air. It is the first of the 
series of paraffins, or saturated hydrocarbons. It is also 
called gas of the acetates, from its method of production. To 
obtain it heat four parts of sodium acetate, four parts of 
sodium hydroxid, and six parts of lime. The true reaction 
takes place between the two sodium compounds. 
NaC 2 H 3 2 + NaOH = CH 4 + Na 2 C0 8 . 

What are compound ethers? Give an example. 

Compound ethers are those in which different aleohol 
radicals replace the two hydrogen atoms of the molecule of 
water. Thus : 

H OH 

C 2 H 5 O C 3 H 7 ; 

or C 5 H 12 Ethyl-propyl ether. 

What is glycerin? 

Glycerin is a bland, heavy, oily-like liquid of a character- 



CHEMISTRY. 187 

istic sweetish taste; a marked attraction for water and great 
solvent powers, particularly for oils, and for many drag sub- 
stances. 

State the preparation, appearance, formula and uses of 
acetic acid. 

Acetic acid may be obtained by destructive distillation of 
wood; the product called pyroligneous acid is subjected to 
certain processes, at the end of which a salt of an acetate, 
generally calcium acetate, results, and from this acetate acetic 
acid is obtained by process of chemical substitution. For- 
mula is HC 2 H 3 2 . 

It is a colorless liquid of strong, sour, pungent odor. Has 
sour and corrosive taste and action. In concentrated form 
it crystallizes at about 60 degrees F. ; in dilute form it con- 
stitutes vinegar. It is used for softening and removing cal- 
lous tissues ; used as a disinfectant ; useful in preparations 
of Basham's mixture. 

What chemical changes take place in the body after 
death? 

The fats undergo decomposition ; oxidation of various tissues 
takes place. The H and S, formerly combined in different 
tissues and in moisture, unite to form H 2 S gas. Phosphorus 
leaves its chemical combinations in bone and other tissue to 
combine with hydrogen, forming PH 3 . Nitrogen unites with 
hydrogen to form NH 3 . The other substances assume finally 
a dry condition after fats, oils and liquids have been dissi- 
pated. 

Define base, basic radical, isomerism. 

A base is the oxid or hydrate of an alkaline or alkaline 
earth metal, or it is a body of electro-positive condition, which 
in solution neutralizes an acid to form salt and water, turns 
red litmus blue, emulsifies fats, and has a harsh acrid taste. 

A basic radical is an atom, or an unsaturated group of 
atoms, having an electro-positive condition and an action 
similar to that of a base. 



188 CHEMISTRY. 

Isomerism refers to the fact that chemical compounds may- 
be composed of the same elements in the same percentage 
proportion by weight yet be different and distinct substances 
having very different properties. 

State the normal reaction of urine. How is the reaction 
noted? To what is it due? 

Reaction acid. By use of litmus paper, which should turn 
red when wet with urine. Acidity due to presence of 
acid phosphate of sodium, and, in a less degree, to presence 
of uric acid (pathological). 

Define qualitative analysis, quantitative analysis. Illus- 
trate each. 

Qualitative analysis consists in breaking up a compound 
or a complex body into easily recognizable, simpler bodies. 
Thus qualitative analysis of cane-sugar shows it to be com- 
posed of C, H, and 0. 

Quantitative analysis seeks to determine the quantity of the 
constituents of a compound. Thus quantitative analysis of 
18 pounds of water shows it to be composed of 2 pounds of 
hydrogen and 16 pounds of oxygen. 

Describe the chemical process for the preparation of 
alcohol. What percentage of alcohol is found in (a) beer, 
(b) wine, (c) whiskey, (d) brandy? 

The fermented liquor from grain is subjected to fractional 
distillation. To the distillate is added oxid of calcium, and 
this mixture again distilled, yielding absolute alcohol, (a) 
Five per cent, (b) Eight to eighteen per cent, (c) Forty- 
five to fifty-five per cent, (d) About fifty per cent. 

Describe two tests for glucose. 

Glucose in solution, if boiled with an alkaline cupric hy- 
drate solution, reduces the copper salt to the red sub-oxid of 
copper, forming a precipitate. 

Glucose in solution placed in the polarizing saccharimcter 
bends the rays of light towards the right. 



CHEMISTRY. 189 

What are peptones and how are they produced? 

Peptones contain C, H, 0, N, S, and sometimes P, and are 
dialyzable, feebly acid products, from the result of the action 
of gastric juice upon albuminous bodies. They are very sol- 
uble in water, and are insoluble in alcohol and ether. They 
are precipitated by heat or acids. They polarize to the left. 
Except mercury, the metallic salts form no precipitates when 
their solutions receive an addition of peptone. They are 
readily assimilable. 

How do globulins differ from albumins? 

Globulins are insoluble in water, but soluble in one per 
cent. NaCl solution. Except vitellin, they are precipitated 
by saturated solutions of NaCl. They are soluble in very 
dilute HC1, 1 to 1000 strength, forming acid albumin. 

Complete the equation: NaC 2 H 3 2 + NaOH =. 
NaC 2 H 3 2 + NaOH = CH 4 + Na 2 C0 3 . 

Explain the nomenclature of binary compounds. Which 
element is to be placed first, and how is the termination 
of the second to be altered? 

Binary compounds are those composed of two elements. 
The electro-positive or metallic element being placed first. 
The second element terminating in ''id." Examples: Ag 2 S, 
argentic sulphid; NaCl, sodic chlorid. 

Define anhydrid, latent heat, gravitation. 

An anhydrid is the name applied to acidulous oxids that 
are capable of combining chemically with water to form 
acids, as SO a , sulphuric anhydrid; N 2 5 , nitric anhydrid. 

Latent heat is heat not manifesting itself as temperature, 
but is required to retain the substance in liquid or in gas- 
eous form. 

Gravitation is the force seeking to draw all substances 
together. It acts upon masses of matter, and the force of its 



190 CHEMISTRY. 

action varies directly as the masses of the attracting bodies, 
and inversely as the square of the distance separating the 
bodies. 

Describe a method of producing an electric current by 
chemical action. 

Immerse two sheets, one of copper and one of zinc, in a 
vessel containing dilute sulphuric acid, and connect them 
outside of the acid by a wire. An electric current will be at 
once produced, starting from the zinc sheet, traversing the 
liquid, being received upon the copper sheet, up which it 
passes to leave the battery cell along the conducting wire 
leading from the copper ; continuing along this wire it returns 
to the battery cell. 

Describe methods for determining atomic weights. 

1. Determine the specific gravity of the element when in 
the gaseous state compared with hydrogen. 

2. The product of the atomic weight multiplied by the 
specific heat being 6.4, then divide 6.4 by the ascertained 
specific heat of the element, the quotient being the atomic 
weight. 

3. Note the weight of an element required to take the place 
of a given weight of hydrogen in forming a replacement or 
substitution compound. Thus acetic acid is HC 2 H 3 2 , and 
practical demonstration shows that one grain of hydrogen in 
acetic acid may be replaced by 108 grains of silver to form 
silver acetate, AgC 2 H 3 2 ; hence one equivalent of silver 
weighs 108 times that of hydrogen, or one atom of silver 
weighs 108 compared to the weight of one atom of hydrogen. 

Explain the difference between metals and non=meta!s. 

Metals are (as a rule) solid bodies of considerable weight, 
more or less malleable, ductile and tenacious. They are good 
conductors of both heat and electricity. When liquefied they 
are opaque to the passage of light. They possess lustre, they 
are electro-positive, they are capable of forming bases, they 



CHEMISTRY. 191 

can displace the hydrogen of acids to form salts. Their 
names terminate in the suffix "urn." 

Substances not possessing most of these characteristics are 
grouped as non-metals or metalloids. 

Explain the process of manufacturing sulphuric acid on 
a large scale. 

Sulfur or a sulfid is burned in a plentiful supply of air, 
and the resulting sulfur dioxid gas, S0 2 , is carried into a 
series of leaden-lined chambers. Along with the sulfur dioxid, 
vapor of nitric acid also enters these chambers; this vapor 
is generally produced through heating a mixture of sodium 
nitrate and sulfuric acid. Steam also is admitted into these 
chambers. The sulfur dioxid becomes oxidized to sulfur tri- 
oxid (S0 3 ) through the action of nitric acid vapor. 

This sulfur tri-oxid then combines chemically with water 
(steam) to form sulfuric acid, H 2 S0 4 . 

Reactions : 

S0 2 + 2HN0 3 = H 2 S0 4 + N 2 2 
Then N 2 2 + air (0 2 ) = N 2 4 
Then 2S0 2 + N 2 4 = 2S0 3 + N 2 2 
Then 2S0 3 + 2H 2 = 2H 2 S0 4 . 
The result is a constant formation of dilute sulfuric acid fall- 
ing in a rain to the floor of the leaden chamber, from there 
removed to be concentrated in glass or platinum stills. 

The last leaden chamber terminates in a tall chimney to 
provide sufficient draft to keep the gases in motion. At the 
beginning of this chimney is arranged a chamber called Gay 
Lussac's tower, in which are packed flints kept moistened 
with strong sulfuric acid. This is for the purpose of absorb- 
ing N 2 4 gas, thus preventing its loss from the chimney. 
This sulfuric acid, charged with the peroxid of nitrogen, is 
used in the first or initial leaden chamber, where spread over 
stones, or falling in cascade, the entering sulfur dioxid gas 
may come in contact with the nitric peroxid gas, thus occa- 
sioning the oxidation of the S0 2 gas. 



192 CHEMISTRY. 

State the symbol, valence and atomic weight of phos- 
phorus. 

Symbol, P; valency, I., III. and V. Atomic weight, 31. 

What is glycogen? From what is it derived? 

Glycogen (C 6 H 10 O 5 ) n resembles starch, forms opalescent 
solution in cold water; derived from liver cells. 

What are albuminoids? Mention some of the import- 
ant albuminoids. 

The class of albuminoids are substances containing carbon, 
hydrogen, oxygen, nitrogen, and generally sulfur or phos- 
phorus. They exist in animal and in vegetable structures. 
They form food substances of great value. They are colloi- 
dal, and are converted by digestion into crystallizable bodies 
called peptones. 

Among albuminoids we find white of egg, blood, meat, peas 
and beans. 

Give and explain (a) an empiric formula, (b) a rational 
formula. 

(a) The simplest possible expression by formula of the com- 
position of a compound, giving the kind of elements present 
and the proportion the number of atoms in a molecule of the 
body bear to each other, thus CH 2 is the empiric formula 
of acetic acid. 

(b) A rational formula shows the manner in which the 
different atoms or radicals combine in order to make one 
molecule of the body, thus HC 2 H 3 2 is the rational formula 
for acetic acid. 

What is the chemical antidote for poisoning from lead 
acetate? Explain the chemical action of this antidote. 

A soluble sulphate, as magnesium sulphate (Epsom salts), 
which in contact with acetate of lead forms an insoluble sul- 
phate of lead. 

Pb2C 2 H 3 2 + MgS0 4 = PbS0 4 + Mg(C 2 H 3 2 ) 2 . 



CHEMISTRY. 193 

Complete the following equations and give the names 
of the resulting compounds: 

HgS0 4 + Hg + 2NaCl = 
FeS0 4 + 2NaHC0 3 = 
HgS0 4 + Hg + 2NaCl == Hg 2 Cl 2 (or 2HgCl) + Na 2 S0 4 

Calomel Sodic sulphate 

FeS0 4 + 2NaHC0 8 = FeC0 3 + H 2 + Na 2 S0 4 + C0 2 

Ferrous -f- water -)- Sodic carbon 

carbonate sulphate dioxid 

Mention five elementary substances commonly used in 
medicine. 

Sulfur, phosphorus, iron, iodin, oxygen. 

Define chemical action, physical action. Give examples 
of each. 

Chemical action takes place in the interior of the mole- 
cule. It is accompanied by the development of heat. Can 
only occur under favorable conditions. When chemical ac- 
tion occurs the identity of the bodies entering into chemical 
action is lost, and new substances are produced. Chemical 
action requires definite weights of the substances between 
which it occurs. 

Physical action takes place outside of the molecule. It is 
not necessarily accompanied by the evolution of heat. The 
substances do not lose their identity. Any quantities of the 
substances may undergo physical action. Examples : Chem- 
ical action, add HC1 to marble dust, forming a gas, carbon 
dioxid ; also forming water and chlorid of calcium. Physical 
action, adding water to sugar we do not lose the characteristic 
properties of the water or of the sugar. 

State the chemical changes produced within a galvanic 
cell while in action. 

Cell composed of zinc and copper with dilute sulfuric acid. 

The acid dissolves zinc, forming a solution of zinc sulphate. 

The hydrogen of the acid, disengaged in bubbles, passes 

through the liquid to the opposite sheet of copper. Thus the 

13 



194 CHEMISTRY. 

strength of acid is constantly lessened through its decompo- 
sition and the formation of sulphate of zinc, until finally all 
acidity will have disappeared from the battery fluid. 

Define distillation, sublimation, destructive distillation. 
Give examples of each process. 

Distillation consists in the passing of a liquid into a vapor- 
ous condition when heated to its boiling point, and the sub- 
sequent condensation of this vapor again to the liquid form 
on cooling the vapor. Example: Distillation of water. 

Sublimation is the passage of a solid into a vapor on being 
heated, and the condensation of that vapor again to the solid 
form on cooling without the substance passing through an 
intermediate liquid state. Example: Subliming iodin, thus 
obtaining it pure. Destructive distillation refers to a form 
of distillation in which the substance in the retort, when 
heated, is entirely destroyed, and from the vapors arising 
new substances are collected when these vapors condense on 
cooling ; thus through destructive distillation of wood we may 
obtain creasote. 

What are the constituents of common illuminating gas? 
How is it prepared? Why is it poisonous? 

Marsh gas, CH 4 ; defiant gas, CH 2 ; acetylene gas, C 2 H 2 . 

Ammonia, hydrogen sulphid, carbon monoxid, carbon di- 
oxid, hydrogen. 

It is prepared from the destructive distillation of bitu- 
minous coal. Its poisonous effects are largely due to carbon 
monoxid present. 

Describe the preparation and appearance of flowers of 
sulfur, roll sulfur, precipitated sulfur. 

Flower sulfur, prepared by subliming sulfur and cooling 
the vapor. It is deeply yellow in color, and examined by the 
microscope shows rounded globular masses. 

Roll sulfur, of yellow color, coming in sticks about two 
feet in length and two inches in diameter. Obtained by 



CHEMISTRY. 195 

pouring melted sulfur into wooden moulds, in which the 
sulfur hardens. 

Precipitated sulfur, the whitest of all the sulfur prepara- 
tions, sometimes called milk of sulfur, is prepared by boiling 
sulfur in an alkaline solution until the sulfur dissolves, when, 
on the addition of hydrochloric acid to this solution, sulfur 
precipitates in a fine almost white powder. 

Mention the substances used for disinfection after the 
prevalence of contagious disease and explain their action. 

Sulfur burned, forming S0 2 , which acts as a disinfectant 
through its dehydrating effect upon germ life. 

Chlorinated lime in presence of acid liberates chlorin gas, 
and this latter, combining chemically with hydrogen of mois- 
ture, sets oxygen free; the oxygen then acts destructively 
upon disease germs. 

What percentage of C0 2 exists normally in the atmos- 
phere? What percentage C0 2 is dangerous to life? 

Atmospheric air contains .04 by volume of C0 2 . A greater 
percentage of C0 2 than .06 by volume would be dangerous 
to life if the C0 2 were accompanied by animal impurities 
from animal respiration. Ten per cent, of C0 2 in air will 
prove poisonous, although unaccompanied by animal respira- 
tory impurities. 

State the properties of nitric acid. 

Nitric acid, aqua fortis, specific gravity 1.5, colorless liquid, 
fuming in air, highly corrosive, stains upon tissues or fabrics, 
not discharged by the use of ammonium hydrate. It turns 
litmus red, will dissolve most of the metals, parts readily 
with its oxygen, forming nitrous acid. 

Define and describe sugars. How do glucoses differ 
from saccharoses? What kind of sugar is found in dia- 
betic urine? 

Sugars are organic compounds called carbohydrates; all 
consist of C, H, and 0, with twice the number of H atoms in 



196 CHEMISTRY. 

each molecule as of atoms. They occur in vegetable and 
animal structures. Glucoses are represented by the formula 
C c H 12 O c ; they polarize light towards the right; they reduce 
cupric hydrate to red sub-oxid of copper. They crystallize 
with difficulty; they are not of as great saccharin strength 
as cane-sugar. 

Saccharoses, formula C 12 H 22 11 , polarize light to the left, 
do not reduce cupric hydrate, readily crystallize, possess 
maximum saccharin effect. 

Glucose is found in diabetic urine. 

Give the chemical name and properties of (a) calomel, 
(b) corrosive sublimate. Mention two easily applied tests 
that will distinguish one from the other. 

Calomel, hydrargyrum mono-chlorid, or mercurous chlorid, 
Hg 2 Cl 2 or 2HgCl. Is a laxative, may by continued use cause 
constitutional poisoning; occurs as an impalpable, insoluble 
powder. When added to lime water a mixture black in color, 
called blaekwash, results, (b) Corrosive sublimate is hydrar- 
gyrum bi-chlorid, or mercuric chlorid, HgCl 2 . 

It is an alterative, anti-syphilitic, antiseptic and highly 
poisonous substance. It occurs in fine crystals, and is slightly 
soluble in water, freely soluble in alcohol. "When to it lime- 
water is added a white mixture results, known as whitewash. 

Give the chemical name of iodoform. How is iodoform 
made? 

Iodoform is the tri-iodid of methane, formed when three 
iodin atoms replace three hydrogen atoms in a molecule of 
marsh gas. Its formula is CHI 3 . It is manufactured by 
boiling a solution of iodid of potassium, potassium hydrate 
and alcohol. 

Define chemistry, physical change, chemical change. 

Chemistry is the science that treats of the ultimate mole- 
cules and atoms of matter, and of the laws that govern their 
changes. A physical change is one taking place outside the 
molecule, and does not result in the loss of properties of the 
bodies engaged, and is not of necessity accompanied by heat. 



CHEMISTRY. 197 

Chemical change only takes place under favorable condi- 
tions between fixed weights of substances, operates in the in- 
terior of the molecule, is accompanied by the evolution of 
heat, the formation of new bodies, and the loss of identity 
of substances undergoing change. 

State the atomic theory. 

All matter is composed of minute quantities of substances 
called molecules, and each molecule is made up of indivisible 
parts called atoms, which in their union to form molecules 
unite in fixed quantities by weight and in obedience to fixed 
laws. 

Give the properties and uses of bromin. 

Bromin is a heavy red-brown liquid, specific gravity 2.99. 
It vaporizes at all temperatures, giving rise to orange-red 
fumes. It is insoluble in water, is caustic, and its vapor irre- 
spirable. It is an electro-negative liquid element. It com- 
bines with many metals to form binary salts, called bromids, 
as NaBr, KBr, AgBr. It is monad in valency. Its solution 
in water is a disinfectant, and bleaches. Its salts, the bro- 
mids, as of iron, arsenic, sodium, potassium, gold, are useful 
in medicine. Bromin is used to make hypobromite of sodium 
for the determination of urea in urine. Bromin forms a scries 
of oxy-salts and oxy-acids. 

State the valence of the following radicals: (CN), (HO), 
(N0 2 ), (CO), (HC). 

CN, monad ; HO, monad ; N0 2 , monad ; CO, diacl ; HC, triad. 

Give the names and formulas of three sodium salts. 

Sodium bromid, NaBr. 
Sodium chlorid, NaCl. 
Sodium iodid, Nal. 

How is ferric chlorid made? Give the chemical equa- 
tions. 

Dissolve iron in aqua regia, or by subjecting iron to the 
action of free chlorin gas. 

Fe 2 + 6HC1 + 2HN0 3 = Fe 2 Cl c + N 2 2 + 4H 2 0. 



198 CHEMISTRY. 

Give in detail a test for arsenic in a mixture of food 
taken from the stomach. 

To the stomach contents add about one-seventh as much, 
by volume, of pure HC1, warm, and at intervals of from 10 
to 15 minutes add potassium chlorate, about a gram at a 
time, continuing the application of heat; soon most of the 
organic matter originally present will be decomposed, when a 
uniform liquid results strain through muslin. Add to this 
liquid sulfurous acid to reduce any arsenic anhydrid, formed 
through the oxidation from potassium chlorate, to arsenious 
anhydrid. 

Heat to drive off any excess of sulfurous acid, then through 
the resulting liquid pass hydrogen sulphid gas fcr several 
hours. Collect this precipitate, and to it add ammonium hy- 
drate, which will dissolve a portion of the precipitate. Test 
this dissolved portion or nitrate for arsenic by Marsh's test. 

Define allotropism. 

Allotropism refers to substances possessing the same chem- 
ical composition, but exhibiting different properties. 

Give the average amount and the composition of normal 
urine voided by an adult in 24 hours. 

Amount 50 ounces 

Water 40 ounces 

Solids 1 000 grains 

Urea 500 " chlorids, K&ISa . 170 grains 

Uric acid 10 " sulphates, K&Ca 40 " 

Hippuric acid • • • 15 " phosphates, K&Na 45 " 

Creatinin 15 " " Mg&Oa ,30 " 

Pigment, mucus 1 ,- ft 

& ' > 179 grains. 

Xanthine, other extractives > 

Give the chemistry of acetic acid and mention the most 
important acetates. 

Acetic acid, HC 2 H 3 2 , is obtained from fermentation 
(acetic acid fermentation) of alcoholic liquids, as cider, etc. 

It may be obtained through the action of sulfuric acid on 
alcohol. 






CHEMISTRY. 199 

Important acetates include acetate of lead, of iron, of alum- 
inum, of sodium, of potassium. , 

Mention five alkaloids. Give the derivation of each. 

Strychnin, from nux vomica ; morphin, from opium ; quinin, 
from cinchona bark; cocain, from erythroxylon coca; atro- 
pin, from belladonna. 

Complete the following equations: 

CH 3 I + HKS = 

CS 2 + 2H 2 + 6Cu = 

CH 3 I + HKS = CH 3 HS + KI 

CS 2 + 2H 2 +6Cu = 2H 2 S + C0 2 + 6Cu. 

State the properties of potassium. Mention ten potas- 
sium compounds of importance in medicine. 

Potassium is a soft white metal, slight bluish tint, decom-r 
poses water at all temperatures, burning in contact with 
water. It is one of the strongest electro-positive elements, 
is of monad valency, is lighter than water, fuses below a red 
heat. 

Compounds of importance in medicine are : 

Potassium iodid Potassium chlorid 
" nitrate " sulphate 

" carbonate " bi-carbonate 

" bromid " cyanide 

chlorate " hydrogen arsenide 

" and antimonial tartrate 

Give a method of determining the specific gravity of a 
solid substance insoluble in water. 

Weigh substance in air, then suspend it in water and 
weigh while immersed, subtract weight in water from weight 
in air, divide weight in air by loss of weight shown when 
weighed in water, quotient will be specific gravity of sub- 
stance. Example: Gold weighs 10 grains in air, in water 
weighs 9% grains, loss equals half a grain, then 10, weight in 
air, divided by one-half, or the loss of weight when in water, 
equals 20, the specific gravity of gold. (True specific gravity 
of gold would be 19.3.) 



200 CHEMISTRY. 

Give the chemical name, properties and uses of tartar 
emetic. 

Tartar emetic is potassium antimony bi-tartrate, or com- 
monly called bi-tartrate of potassium and antimony. For- 
mula: KSbOC 4 H 4 O c . 

It is an impalpable white soluble powder, sublimes when 
heated, is very poisonous. Used as an emetic and as a nau- 
seating and sedative expectorant. 

In what part of the body is sulfur found? 

Sulfur exists in all tissues and fluids of the body that pos- 
sess color. Sulfur is present in the different substances of 
an albuminoid nature. 

What kind of albumin in morbus Brightii? What prop- 
erty renders it readily detectable? 

Serum albumen. 

It is readily detected through its coagulability by heat or 
acid. 

How is chlorinated lime made? What is the principal 
use of chlorinated lime? 

By passing chlorin gas over slaked lime, spread upon 
shelves in a properly constructed room. 

Ca2HO + Cl 2 = CaClOCl + H 2 0. 

Its chief uses are as a bleaching agent and a disinfectant. 
In both instances its action only takes place in the presence 
of moisture, when the chlorin that it disengages combines 
chemically with the hydrogen of moisture, thus freeing the 
oxygen from moisture to act as the real disinfectant or bleach- 
ing substance. Chlorinated lime liberates chlorin when in 
contact with an acid. 

What is the difference between an alcohol and a phenol? 
Illustrate. 

Phenols differ from alcohol in: 

1st. Not forming corresponding aldehydes and acids on 
oxidation. 



CHEMISTRY. 201 

2d. In not dividing into water and hydrocarbons under 
the influence of dehydrating agents. 

3d. In not reacting with acids to form ethers. 

Phenols form more stable compounds with metal elements 
that more closely resemble salts. 

What are carbohydrates? Into what three groups are 
these compounds usually divided? 

Carbohydrates are organic compounds, composed of C, H, 
0, in which the H and exist in the relative proportions 
in which they are present in water. 

Amyloses, glucoses, saccharoses. 

Give the formula, uses and properties of hydrogen 
dioxid. 

H 2 2 . Used as a disinfectant, and a bleaching agent, and 
an oxidizing substance. Used in restoring oil paintings. 

It is usually sold in a watery solution containing from 10 
to 12 volumes of true hydrogen dioxid, or of about 3 per cent, 
in weight. True peroxid of hydrogen is a thick, syrup-like 
liquid obtained through the evaporation of watery solutions 
of peroxid of hydrogen over strong sulfuric acid in a vacuum. 

Peroxid of hydrogen readily parts with an atom of oxygen, 
particularly if brought in contact with organic matter, and 
it is this nascent oxygen that effects the bleaching, disinfec- 
tant action, etc. 

Give the formula and properties of each of two oxids of 
carbon, explaining the effect of each on animal life. 

Carbon-monoxid, CO. 

This substance is a gaseous body, almost insoluble in water, 
no odor, burns with blue flame to form carbon dioxid. 

It acts as a direct poisonous agent to animals, causing de- 
composition of blood. 

Animals poisoned through the action of carbon-monoxid 
have the oxygen-carrying power of the red blood corpuscles 
destroyed. 

Carbon-monoxid is lighter than air. 



202 CHEMISTRY. 

Carbon-dioxid, C0 2 , is a colorless gas, heavier than air, no 
odor, soluble in water, upon which it confers increased sol- 
vent powers. It is a normal constituent of air. It is not a 
direct poison when inhaled, except it be in quantities consti- 
tuting over 10 per cent, of the inhaled air. It is, however, 
not capable of supporting life. 

It does not burn, nor does it support combustion. 

It enters the air from respiration of animals, and in such 
respiration poisonous materials are exhaled accompanying the 
carbon-dioxid. 

It is to these poisonous matters from animal respiration, 
and not to the presence of carbon-dioxid, that the deleterious 
effect of breathing pre-breathed air is due. 

Describe the preparation of nitrous oxid, writing the re- 
action. State the properties and use of nitrous oxid. 

Nitrous oxid results when ammonium nitrate is heated in 
a retort at temperatures between 460° to 490° Fahr. 
NH 4 N0 3 + heat = N 2 + 2H 2 0. 

It is a colorless gas, slightly sweetish taste, has no odor. 
It is soluble in water, heavier than air. It readily supports 
combustion, owing to its decomposition by the heat of the 
burning body introduced in it, so that it is actually the liber- 
ated oxygen that supports combustion. It does not burn. It 
is used for the production of general anesthesia of but a 
short duration. It is regarded as the safest of general anes- 
thetics, and has a large use in dentistry for operations of 
a short duration. A common name applied to it is "laugh- 
ing gas." 

Describe phosphorus as to (a) derivation, (b) proper* 
ties, (c) commercial uses, (d) medicinal uses, (e) medic- 
inal preparations. 

(a) From apatite or from bones, each of these substances 
containing tri-calcium phosphate. 

(b) In its usual form is a yellow wax-like solid, occurring 
also in red, black and white allotropic forms. 



CHEMISTRY. 203 

Yellow phosphorus is spontaneously inflammable in air, 
especially if it be finally divided, it has an odor of garlic, is 
highly poisonous, is insoluble in water, but dissolves in oils, 
in bi-sulphid of carbon, slightly soluble in hot alcohol, etc. 
It glows in the dark, it melts and will take fire below the 
boiling-point of water. It can be burned under water in a 
jet of oxygen gas. Takes fire on contact with iodin, bromin. 

(c) Making matches, insecticides. Is used in certain metal 
alloys to give closer grain and prevent oxidation in the alloy, 
as in phosphor bronze. 

(d) Used medicinally in doses of l-100th of a grain as a 
nervous reconstructive drug. Has considerable use in treat- 
ing many nervous disorders. 

(e) Medicinal preparations — phosphorus, phosphoric acid 
dilute, the phosphates, as of sodium, iron, etc., the hypophos- 
phites of metals, and of alkaloids as well. 

Define reaction. 

When one active chemical substance is brought in contact 
with another, separation of the constituents of each substance 
occurs, and then these constituents rearrange themselves to 
form new bodies; this is the reaction that follows the initial 
chemical action. 

Give the names and formulas of the various gaseous 
compounds capable of producing general anesthesia. 

Nitrous oxid, N 2 ; chloroform, CHC1 3 ; ether, (C 2 H 5 ) 2 0. 

A few other substances are used for the production of 
anesthesia, but they have not as general a use nor as satis- 
factory an action as those given. 

Describe a method of detecting the presence of lead 
salts in water. 

Concentrate the water to small bulk, add a few drops of 
ammonium hydrogen sulphid, when a black precipitate or 
coloration appearing may indicate the presence of lead or 
other deleterious metallic additions to the water. 



204 CHEMISTRY. 

This test is usually performed upon water two feet in 
depth in a tall glass cylinder. 

How may the presence and amount of urea be deter- 
mined? 

Make a fresh solution of hypo-bromite of sodium by dis- 
solving 100 grams of caustic soda in 250 cubic centimeters 
of water, and when cold adding 25 grams of bromin. 

Place this solution in the closed arm of a Doremus' ureo- 
meter. Now add one cubic centimeter of urine, so that it 
may mix with the hypo-bromite solution in the closed arm of 
the apparatus. The urea present is decomposed, its compo- 
nents are absorbed with the exception of nitrogen gas, which, 
passing to the upper portion of the tube, depresses the column 
of liquid downward. The space occupied by the nitrogen 
gas then serves to indicate the quantity of urea in the one 
cubic centimeter of urine operated upon. 

Mention a chemical antidote for sulfuric acid and ex- 
plain the action of this antidote. 

Magnesium oxid. 

It chemically combines with sulfuric acid to form sulphate 
of magnesium. This action is accompanied by the evolution 
of but little heat and no gas, and all corrosive properties of 
the acid entirely disappear in the change or neutralization 
that it undergoes. 

What is fermentation and how is it produced? What 
are enzymes? 

Fermentation is the decomposition of a non-nitrogenous 
body brought about through the presence of a nitrogenous 
body called a ferment. For its production we require a non- 
nitrogenous substance, a ferment, moisture, presence of air 
(generally), a temperature not exceeding 100° to 110° Fahr. 

Enzymes are soluble or unorganized ferments acting like 
yeast and other recognized ferments. They are of both vege- 
table and animal origin. Those of animal origin are found 
in digestive fluids, as pepsin in gastric juice, ptyalin in saliva. 



CHEMISTRY. 205 

Differentiate chemically sucrose, glucose, lactose and 
maltose. 

Sucrose, C 12 H 22 11 , does not reduce cupric salts. 

Glucose, C 6 H 12 6 , reduces cupric salts. 

Lactose, C 12 H 22 11 H 2 0, polarizes light to the left. 

Maltose, C 12 H 22 11 H 2 0, very soluble in water. 

Complete the following equations: 

FeCl 3 + 3NH 4 OH = 

MgCl 2 + NH 4 C1 + Na 3 P0 4 =. 

FeCl 3 + 3NH 4 HO = Fe3HO + 3NH 4 C1. 

MgCl 2 + NH 4 C1 + Na 3 P0 4 = NH 4 MgP0 4 + 3NaCl. 

Describe oxygen as to occurrence, preparation, physical 
properties, chemical properties, office in the body. 

Oxygen occurs mixed with nitrogen to form atmospheric 
air. It is found chemically combined with y 8 of its weight 
of hydrogen in water. It is present in many compounds, as 
the oxids, oxy-acids, oxy-salts, hydrates in both mineral and 
organic compounds. 

It is the most widely distributed of elementary substances, 
and constitutes one-third of all matter. 

It is prepared by heating a mixture of potassium chlorate 
and manganese dioxid. Physically, oxygen is a colorless, 
tasteless, odorless gas, slightly heavier than air, its specific 
gravity being 1.1056. It is soluble to the extent of 3 per 
cent, in water. It can be liquefied, when it resembles water, 
and when solidified appears like ice. 

Chemically, oxygen supports combustion, does not burn, is 
strongly electro-negative, is of diad valency, combines chem- 
ically with all elements excepting fluorin and argon. 

It supports animal respiration; it is carried by the red 
blood corpuscles to every tissue of the body, upon which it 
acts destructively to allow of constant regeneration of tissues. 

It is used remedially where from any cause respiration is 
impaired or prevented. 



206 CHEMISTRY. 

What is chlorin? How is it prepared? How is chlorin 
administered medicinally through the mouth? 

A heavy green gas about 2y 2 times the weight of air, freely 
soluble in water, generally administered in watery solutions 
known in pharmacy as aqua chlorini. 

Prepared by heating a mixture of manganese-dioxid and 
hydrochloric acid, and collecting the gas evolved by dis- 
placement. 

Mn0 2 + 4HC1 = MnCl 2 + 2H 2 + Cl 2 . 

Define alloy, amalgam. Give an example of each. 

An alloy is a combination of two or more metals. Example : 
Brass, an alloy of zinc and copper. An amalgam is an alloy 
in which one of the metals is mercury. Example : Tin amal- 
gam, composed of tin and mercury, used in making of mirrors. 

How is hydrogen sulfid formed in nature? How is 
hydrogen sulfid prepared in the laboratory? 

It results, in nature, from the decomposition of organic 
matter containing sulfur in the presence of moisture. Ex- 
ample: The rotting of an egg gives rise to hydrogen sulfid 
from the union of the sulfur in the albumen with the hydro- 
gen of water. 

Hydrogen sulfid may be prepared in the laboratory by 
adding dilute sulfuric acid to ferrous sulphid, as 
FeS + H 2 S0 4 = PeS0 4 +H 2 S. 

Explain the significance of the following prefixes: 
Hydro, sub, hyper, nitro, bi. 

Hydro indicates the presence of hydrogen in chemical com- 
bination with another element. Hydro-chloric acid, HC1, 
affords an example. 

Sub refers to a compound in which a less number of atoms 
so designated are present in a molecule than the number of 
atoms of the other body that is present. Example: Ag 2 0. 
Sub-oxid of silver takes its name from the fact that there is 
a less number of oxygen atoms than of silver atoms. 

Hyper has an opposite significance to sub, as C1 2 7 is 



CHEMISTRY. 207 

called hyper-chloric oxid to distinguish it from C1 2 5 , called 
chloric oxid. 

Hyper here implies a greater amount or larger number, 
referring in this instance to the number of oxygen atoms that 
exist in chloric oxid. 

Nitro indicates the presence in a compound of the radical 
N0 2 , as C 6 H 7 (3N0 2 )0 5 as tri-nitro-cellulose. 

Bi indicates two atoms of the element so designated in 
chemical combination with another element, as CS 2 means 
bi-sulfid of carbon. 

Mention the metals whose salts are often taken as 
poisons. 

Silver, lead, mercury, arsenicum, antimony, copper, tin, 
zinc, barium. 

What is common salt? State where and how common 
salt is obtained, and give the chemistry of its use for 
freezing purposes. 

Sodium chlorid, NaCl. 

By evaporation of sea water. 

By evaporation of water in which sodium chlorid is dis- 
solved, as in natural mineral springs, and this brought about 
through flooding cuttings that pass through a salt-bearing 
stratum of rock, and then evaporating such water. 

Large quantities of salt are obtained from the vicinity of 
Syracuse. 

When salt is mixed with snow or ice it occasions the rapid 
liquefaction of the snow or ice, and in this act heat is ren- 
dered latent, and heat so rendered latent is extracted from 
bodies near the liquefying ice. 

Explain the formation of a vesical calculus having a uric 
acid nucleus. 

An aggregation of uric acid crystals, from their sharp 
angular character, produce much irritation to vesical mucous 
lining, so that they become surrounded with deposits of 
mucus, and then, from inflammation produced, we may have 



208 CHEMISTRY. 

decomposition of urine, which acquiring an alkaline reaction 
occasions formation and deposition of alkaline urates, or per- 
haps phosphates, around the original mass, thus forming a 
mixed calculus. 

Give two tests for morphin. 

Touch the suspected alkaloid with nitric acid, and if it be 
morphin it dissolves, yielding an orange-red liquid that soon 
fades to yelloAV. 

To morphin add neutral ferric chlorid solution — a blue 
color is produced. 

When are substances said to be (a) isomeric, (b) meta- 
meric, (c) polymeric? 

Bodies are truly isomeric when they are made up of the 
same elements in the same percentage proportion and have 
the same molecular formulas, containing the same elements or 
radicals, but such elements or radicals uniting in different 
groupings give rise to different bodies. 

Two or more bodies are metameric when composed of the 
same elements in the same percentage composition and have 
the same molecular formulas but contain different radicals. 

Polymeric bodies are composed of the same elements in the 
same percentage composition but show different molecular 
formulas. 

Write a reaction for making barium sulphate from 
sodium sulfate. How many grams of sodium sulfate are 
required to yield 2.33 grams of barium sulfate by this 
process? (Atomic weight of barium equals 37.) 
Na 2 S0 4 + BaCl 2 = BaS0 4 + 2NaCl. 

142Na 2 S0 4 make 233 of BaS0 4 . 

If 233 grams of barium sulfate require 142 grams of sod- 
ium sulfate, then 233:142: : 2.33 :X, or 1.42. 

Result, 1.42 grams of sodium sulfate required. 

Describe and illustrate (a) monobasic acid, (b) dibasic 
acid, (c) tribasic acid. 

(a) An acid containing one atom of hydrogen that is cap- 



CHEMISTRY. 209 

able of being replaced by a metal or an electro-positive 
radical, as HC 2 H 3 2 , acetic acid ; AgC 2 H 3 2 , argentic acetate. 

(b) An acid which contains two replaceable hydrogen 
atoms in each molecule, as H 2 S0 4 , sulfuric acid; Na 2 S0 4 , 
sodium sulfate. 

(c) An acid which contains three replaceable hydrogen 
atoms in each molecule, as H 3 P0 4 , phosphoric acid; Na 3 P0 4 , 
basic sodium phosphate. 

Write chemical equations showing two methods of ob= 
taining hydrogen. 

Zn 2 + 2H 2 S0 4 = 2ZnS0 4 + 2H 2 . 
Zn 2 + 4KOH = 2K 2 Zn0 2 + 2H 2 . 

What is the meaning of the words monad, tetrad and 
pentad? Give an example of each? 

Monad refers to an element or compound radical whose 
power of combination by volume is the same as hydrogen 
exhibits. That is, one quart of the substance would combine 
with one quart of hydrogen if such chemical union were 
possible and the elements were in a gaseous condition. Thus 
chlorin is a monad, as it combines with hydrogen in equal 
volumes, and theoretically it is claimed that this combination 
takes place with one atom of H uniting with one atom of 
chlorin. 

Tetrad is an element or compound radical exhibiting a 
combining power four times that possessed by hydrogen, or 
it is an element that would require four times its own volume 
of hydrogen to completely satisfy its desire for chemical 
union. Example: Carbon, as in marsh gas, CH 4 . 

A pentad exhibits in its atom a desire to combine with five 
hydrogen atoms, or five atoms of a monad substance. Ex- 
ample: Phosphorus, as in its compound phosphoric chlorid, 
PCI,. 

Describe cyanogen and its principal compounds. 

Cyanogen, C 6 N 6 ; symbol, Cy or CN. 

This body is an organic compound radical composed of 
14 



210 CHEMISTRY. 

equal volumes of carbon and nitrogen vapors. Cyanogen is 
studied in its molecule. It is a colorless, inflammable gas, 
soluble in water. It exists in a divided form in many vege- 
table structures, as in peach kernels. It is electro-negative 
or acidulous, is of monad valency, acts like chlorin in chem- 
ical compounds which it forms. 

Important compounds: Hydrocyanic acid, HCN. In one 
per cent, watery solution, called prussic acid. Very poison- 
ous, colorless, water-like liquid. 

KCN, potassium cyanid, used in doses of % grain for same 
purposes (sedative) as hydrocyanic acid. 

Potassium ferro-cyanid and potassium ferri-cyanid have 
considerable use in arts and manufactures. 

Nickel, silver and gold cyanids are all used for electro- 
plating purposes. 

What are the source and principal properties of vaseline? 

Vaseline is a fat-like mass of from white to yellow color, 
obtained by purifying the residue, after distilling the more 
volatile substances from petroleum. 

It is more or less fluorescent; it melts at from 104 to 125 
degrees Fahr. It is almost odorless and tasteless. 

Give the general characteristics of the aluminum group 
of elements. 

Metals of aluminum group include aluminum, indium, gal- 
lium. They are tri-valent, forming compounds like MC1 3 or 
M 2 3 . Here M stands for the aluminum or similar metal. 

Their oxids are weak bases; their sulfates of alkali metals 
form double salts called alums, which crystallize in the reg- 
ular isometric system. 

Oxids and hydrates are insoluble in water, as are the phos- 
phates and carbonates of these metals. 

Give a typical example of each of the following classes 
of mineral waters: (a) Saline cathartic, (b) alkaline, (c) 
sulfurous. 

(a) Epsom spring water (England), containing magnesium 
sulfate. 






CHEMISTRY. 211 

(b) Buffalo lithia water, containing lithium carbonate. 

(c) Waters, natural, in vicinity of volcanoes, as in Island 
of Sicily, Iceland, the Yellowstone; such water contains sul- 
fur dioxid gas in solution. 

Describe one of the processes by which HC1 and N may 
be prepared. 

HC1 is prepared by heating sulfuric acid and common salt 
and passing the evolved gas into water. 

N is prepared by passing air over copper heated to redness. 
The oxygen being retained by the copper allows the nitrogen 
to pass at the distal end of the outlet tube. 

Explain the difference between the Fahrenheit, centi= 
grade and Reaumur thermometers. 

The freezing-point of water in the Fahrenheit scale is 
marked 32 degrees, while in Centigrade and Keaumur scale 
this point is marked zero. The boiling-point in the Fahren- 
heit scale is 212 degrees, the Centigrade scale 100 degrees, 
Reaumur 80 degrees. It will thus be seen that between the 
freezing- and boiling-points of water in the F. scale we have 
180 degrees, in C. scale 100, in R. 80. Hence each degree F. 
would correspond to f of a degree C. and | of a degree R. 

What is litmus? Explain its uses in urinalysis. 

Litmus is a vegetable substance obtained from a species of 
lichen. 

It is sold in the shops in small blue cubes. It is obtained 
by subjecting the plant to the action of alkaline solutions, 
evaporating, and adding plaster of Paris. It dissolves in 
water; its color, owing to its formation through the use of 
an alkali, is blue, it gives blue solutions, it stains bibulous 
paper blue, it is turned red on contact with acids. Its color 
is due to the presence of a weak acid, while the salts formed 
by the union of this acid with bases are blue. In urinalysis 
we use it generally in the form of litmus paper to determine 
the reaction of urine. 



212 CHEMISTRY. 

Give the chemical differences between chloral and chlo= 
roform. 

Chloral is aldehyde, in which three atoms of hydrogen of 
an alcohol radical have been replaced by chlorin atoms, as 
alcohol, C 2 H 5 OH; aldehyde, C 2 H 3 OH; chloral, C 2 C1 3 0H. 

It is tri-chlor-aldehyde. 

Chloroform is tri-chlor-methane, or marsh gas, in which 
three hydrogen atoms in each molecule are replaced by chlorin 
atoms, as marsh gas, CH 4 ; chloroform, CHC1 3 . 

Chloral contains oxygen in its composition; chloroform 
does not. 

Complete the following equations: 

CaCl 2 + (NH 4 ) 2 C0 3 = 

CH 4 N 2 + 2H 2 = 

CaCl 2 + (NH 4 ) 2 C0 3 = GaCOg + 2NH 4 C1. 

CH 4 N 2 + 2H 2 = (NH 4 ) 2 CO s . 

Define malleability, endosmosis. 

Malleability refers to the property possessed by metals of 
being hammered or rolled out into thin sheets. Endosmosis 
refers to the act of a liquid of a certain density passing 
inward through a porous partition to mix with a liquid of 
different density on the interior of the porous partition. 

Give the general characteristics of rain water, well 
water, river water, and lake water. 

In order of usable quality we would rank 

Rain water, pure. 

Well water, impure. 

River water, suspicious. 

Lake water, good. 

Rain water is always soft, well water and rain water gen- 
erally hard, lake water usually soft. 

In well water we are apt to find impurities deposited from 
the soil or carried, through the action of rain, from stable 
and other deposits of filth into the general well contents. 



CHEMISTRY. 213 

This is particularly true in the case of shallow wells. 

River water is apt to be contaminated by sewage and waste 
from cities and manufacturing plants, from the facility river 
currents offer for the disposal of waste material. 

Rain water may be very impure at first of a storm, but 
after a few minutes, impurities, dust and other material 
having been washed from the air, then should rain water be 
collected; it affords the purest natural supply. 

Lake water, unless near settled communities, contains only 
harmless vegetable contamination. 

Give the method of preparation and the special charac- 
teristics of ozone. 

It may be prepared by passing moist air or oxygen through 
a ''Siemens" induction tube, while the tube has traversing 
it silent electric discharges. 

So prepared, ozone is a blue gas of very irritating effect 
upon respiratory mucous surfaces, of very active oxidizing 
and corroding action, acting directly to cause oxidation of 
substances that ordinarily resist the action of oxygen, as 
silver. 

Test for ozone : Bibulous paper is saturated with a mixture 
of starch mucilage and potassium iodid solution. 

This paper will be turned blue in contact with even minute 
traces of ozone. 

What is fluorin and where is it obtained? State the 
preparation and the practical uses of hydrofluoric acid. 

Fluorin is a yellow gas, slightly heavier than air, is electro- 
negative, cannot be forced to combine with oxygen, has 
marked affinity for hydrogen and for some of the metals. 

It occurs in nature in combination with metals as nuorids, 
as the fluorid of calcium or fluorspar, CaF 2 . 

Hydrofluoric acid is made by heating calcium fluorid and 
sulfuric acid in a leaden vessel and passing the evolved gas 
into water, in which it readily dissolves. This gives us a 
watery solution of hydrofluoric acid. Its chief use is as a 
solvent for glass ; from this action it is known as the etching 
acid. 



214 CHEMISTRY. 

It is also used in the manufacture of peroxid of hydrogen. 

What are the constituent parts of boroglycerid and what 
is its use in medicine? 

Boroglycerid is an ether obtained by boiling boric acid in 
glycerin. 

U. S. P. Glyceritum boroglycerini, 31 per cent, boric acid 
dissolved in glycerin. 

It is antiseptic and detergent. 

What are the properties of lead? What is litharge? 
Give the toxicology of lead. 

Lead is a soft, heavy, bluish-white metal. Atomic weight, 
206. Melts below a red heat, oxidizes when heated in air to 
form yellow oxid of lead or litharge. 

Lead is soluble in nitric acid, in acetic acid, in very strong 
hot sulfuric acid. Exposed to air a basic carbonate of lead 
forms upon the surface. Same occurs in water containing 
carbon-dioxid. 

Litharge is monoxid of lead, PbO. It is yellow in color; 
obtained by heating lead (melting) in air. 

Antidote for soluble lead salts is a soluble sulfate, as 
Epsom salt. 

Lead may occasion acute or chronic poisoning. 

In acute lead poisoning we have the action of an irritant — 
vomiting, purging, abdominal cramps, etc. 

Chronic lead poisoning, as it occurs in painters or those 
constantly exposed to the fumes of lead and its components, 
is characterized by paralysis of extensor muscles, producing 
"wrist-drop" in the case of painters; also many obscure 
nervous symptoms, paralyses, anesthesias, etc. 

Give the preparation, formula and characteristics of 
bromid of ammonium. 

Bromid of ammonium may be thus obtained: 
Place one pound of bromin in a stone jar, add to it care- 
fully four times its weight of water, then add half ounce at 
a time, very slowly, one quart of ammonia. The resulting 



CHEMISTRY. 215 

solution from crystallization or granulation will yield am- 
monium bromid. 

6Br + 8NH 3 = 6NH 4 Br + N 2 . 

Formula of ammonium bromid, NH 4 Br. 

It is a white cubical salt, soluble in water; heated with 
caustic soda evolves odor of ammonia. 

Passing chlorin gas through its water solution we have 
bromin disengaged. 

Ammonium bromid acts upon the system like potassium or 
sodium bromid, as a depressant to the motor function of 
spinal cord. Its chief uses are to produce sleep and allay 
nervous irritability. 

Give a description of the preparation and mention the 
properties of the principal alcoholic beverages obtained 
from the fermentation of malted grains. 

The brewer "mashes" the ground malt with water, and 
heats at about 180 degrees F. for several hours, when such 
starch as has not been changed by germination of the grain 
in the malt now undergoes change into dextrin and sugar. 

The liquid resulting is "wort." 

Wort is now boiled with about ^ as much hops as was 
used of malt originally. 

This hopped wort is allowed to stand and the clear portion 
drawn off in shallow coolers, and its temperature lowered 
to about 60° F. Then about T ^ of its volume of yeast is 
added and the liquid allowed to ferment in large vessels or 
tuns. As the result of fermentation glucose is changed to 
alcohol, with a further formation in the liquid of lactic, 
succinic, carbonic and acetic acids, glycerin, etc. 

The fermentative process is now stopped by heating the 
liquid sufficiently high to kill the yeast plant (pasteurizing). 

Ale, porter, stout, differ from beer only in the selection and 
proportion of the malt, hops and flavoring material. 

Beer. Stout. Ale. 

2.78 6.66 6.25 Alcohol 

6.05 7.24 6.98 Solid extractive 

.12 .20 .14 Free acid 



216 CHEMISTRY. 

What is the normal amount of uric acid excreted in 24 
hours by an adult, and what effect has diet on the quantity 
so excreted? 

About 10 grains in 50 ounces of urine excreted in 24 hours. 
(Holland.) 

Increased during a diet rich in nitrogen, as of meats, peas, 
beans, eggs, etc., and alcoholic beverages. 

What is the fever thermometer? How is it made and 
graded? 

A small glass thermometer of a minute capillary bore, with 
a constriction in the lumen of the capillary tube immediately 
above the mercurial chamber. 

The mercury, in its expansion, passes through the con- 
stricted parts of the tube, but on cooling and contracting 
cannot, by its own weight, fall down the tube past the con- 
stricted portion. 

It is made like other thermometers by certain steps. 

1st. Calibrating the tube. 

2d. Filling the tube. 

3d. Curing the tube. 

4th. Graduating the thermometer. 

It is usually graduated from 90 degrees Fahr. to 110 de- 
grees Fahr. Each degree divided into five equal spaces. 

What is the relative importance of the element carbon 
in organic chemistry? 

All organic compounds contain carbon. 

It is the essential, necessary element whose presence classes 
the body as organic. 

Inorganic compounds occur in small number that contain 
carbon, as in the salts known as carbonates and bi-carbonates. 

In testing urine by heat in a case of suspected albu= 
minuria, what substances might be precipitated and so 
make the test deceptive? 

Phosphates. 



CHEMISTRY. 217 

Describe the chemical process (a) when iron rusts, (b) 
when wood burns, (c) when silver is tarnished by coal gas. 

In rusting of iron the final product is Fe 2 3 , ferric oxid. 

Wood burns to form carbon-dioxid and water. 

The carbon and the hydrogen of the wood uniting with 
oxygen from the air and from the wood itself when influ- 
enced by heat. 

Silver, in presence of coal gas, becomes coated with a black 
sulfid of silver, AgS, from the presence in the coal gas of 
sulfur gases, as hydrogen sulfid and ammonium sulfid. 

How is collodion prepared and what are its uses? 

Collodion is a gun cotton, made, however, through the 
action of dilute nitric and dilute sulfuric acids upon clean 
raw cotton. 

This substance is dissolved in ether, and its etherial solu- 
tion when painted upon denuded surfaces deposits a coating 
of collodion as a protective to such surfaces when the ether 
evaporates. 

Describe the manufacture of illuminating gas. 

Soft coal is heated in closed retorts, and the resulting 
vapors from its decomposition pass into: 

1st. A hydraulic "main," which is a large pipe half filled 
with water; the gases passing into the water emerge, and 
traveling along the upper portion of the main, then pass into 

2d. Out-air condensers, which consist of tubes in the outer 
air, placed in perpendicular stacks. Then having traversed 
the out-air condensers the gas is conducted into the 

3d. Scrubbing room, in which it comes in contact with thin 
films of water, and is in this manner washed and freed of 
certain substances, the most important being ammonia. The 
gas now passes into 

4th. The lime chamber, where the gas is freed of sulfur 
compounds through the action of lime, sulfate of iron and 
charcoal. After all of these methods of purification, the re- 
sultant is then stored as illuminating gas for distribution to 
the consumer. 



218 CHEMISTRY. 

In the retort is left gas-carbon and coke ; from the hydraulic 
main and out-air condensers coal tar is removed. 

From the scrubbing room ammonium hydrate is obtained. 
From the lime chamber calcium sulfid is obtained. 

Mention the antidotes applicable in cases of poisoning 
from (a) caustic alkalies, (b) carbolic acid. 

(a) Vinegar, lemon juice, oils, fats, mucilaginous drinks. 

(b) Soluble sulfates, as magnesium sulfate, oils, fats, albu- 
men, vinegar, and alcohol. 

Where is oxygen found in the human body and what 
are its important uses in the animal economy? 

It is present in moisture, hence in all animal tissues and 
fluids. 

It is also found in many salts and compounds, both in- 
organic and organic. 

Oxygen promotes the destruction and removal of existing 
tissues, with subsequent replacement by new structures. 

It is only through the ingestion of oxygen, in respiration, 
that animal life may continue. 

When sulfur is burned in the air, what is the product 
and what are its uses? 

Sulfur dioxid, or sulfurous anhydrid, S0 2 . 

It bleaches organic colors ; it is a disinfectant gas. It stops 
or limits fermentation; in the arts it is used for the manu- 
facture of sulfuric acid and other chemical bodies. It is used 
in organic chemical analysis and in metallurgy, as in the 
reduction of certain ores. 

Describe bromin. 

A heavy dark-red liquid element, vaporizing at all temper- 
atures as an orange-red gas. 

Slightly soluble in water, possessing bleaching and dis- 
infectant powers. It is strongly caustic, electro-negative, 
monad in valency. Atomic weight 80, specific gravity, 2.99 ; 
prepared by passing chlorin gas through concentrated solu- 



CHEMISTRY. 219 

tions of bro mids. Combines with metals, forms oxy-acids and 
oxy-salts. 

Write the formulas for (a) sodium sulphate, (b) potas= 
sium nitrate, (c) ammonium chlorid. 

(a) Na 2 S0 4 . (b) KN0 3 . (c) NH 4 C1. 

Describe the method of obtaining H and O by passing 
an electric current through H 2 0, and tell how to deter= 
mine which gas is O. 

Seal two platinum wires in the opposite sides of a glass 
flask, solder two upright strips of platinum to these entering 
horizontal wires. Connect one of the entering wires with the 
positive wire of a galvanic battery of several cells. Connect 
the other wire that enters the glass vessel with the negative 
wire from the battery. Now invert two long glass tubes that 
have been filled with water, in this cup or vessel, that has 
itself been partially filled with water. The water will be 
retained in the tubes through atmospheric pressure, and the 
tubes will be placed, mouth downward, over each of the plat- 
inum slips; allow the current to pass, when each tube will 
fill with gas, the water it contains being displaced. The tube 
which will contain oxygen gas fills with half the rapidity 
of the opposite tube, and if this tube be removed from the 
apparatus and held in an upright position, a fragment of 
wood, glowing, but not actively burning, will kindle into 
brilliant flame when plunged into the tube. 

What is effervescence and what is efflorescence? 

Effervescence refers to the escape of gas through a liquid, 
in which the gas has been held under pressure. This process 
produces bubbling, as we see in soda water. 

Efflorescence refers to the loss of water of crystallization 
which certain crystals undergo when exposed to air. They 
dry out, become powdery, losing their crystalline form, as 
we see in the case of alums. 



220 CHEMISTRY. 

What changes take place in alcoholic fermentation? 

Glucose is converted into alcohol and carbon dioxid gas : 
C 6 H 12 6 = 2C 2 H 5 OH + 2C0 2 . 

What is understood by specific gravity, and what pre= 
cautions are advisable in the use of the urinometer? 

(a) By specific gravity of a substance we mean the ratio, 
or relation by weight, the substance bears to the weight of 
an equal volume of some substance used as a standard, when 
both substances have the same standard temperature and are 
under normal pressure. 

(b) Bring the temperature of the liquid to be examined 
(urine) to 60° Fahr. ; free the instrument, particularly its 
stem, of any adhering bubbles. Note on the scale of the in- 
strument the degree corresponding to the level of liquid in 
the surrounding jar, not recording the degree as shown 
through capillary action in the ascent, up the stem, of a thin 
film of liquid. 

Give the chemical name and formula of (a) water, (b) 
common salt, (c) carbonic acid, (d) nitric acid. 

(a) Hydrogen monoxid, H 2 0. (b) Natrium chlorid or 
sodic chlorid, NaCl. (c) Carbon dioxid gas, C0 2 ; true hy- 
drogen carbonate, H 2 C0 3 . (d) Hydrogen nitrate or hydric 
nitrate, HN0 3 . 

How does fire=damp explode in mines? 

When marsh gas escapes from fissures in coal formations 
and mixes with air, such mixtures explode with great violence 
when heated, as from a naked flame of a lamp, the chemical 
results being to form carbon dioxid and water. 

If the proportion of air rises to 18 times the volume of 
marsh gas no explosion occurs. 

Demonstrate the fact that air is a mixture, and not a 
compound. 

Pass air through water that has been boiled, and 3 per 
cent, of the oxygen of the air will be retained dissolved in 



CHEMISTRY. 221 

the water, while less than 1 per cent, of nitrogen will be re- 
tained by the water. 

Through this method of solution of oxygen we may entirely 
extract the oxygen from atmospheric air. 

What is the chemical antidote in case of poisoning by 
tartar emetic? 

Tannic acid. 

What is the formula of sulphuretted hydrogen? What 
are some of its properties and uses? 

Sulphuretted hydrogen, H 2 S, is a colorless gas, slightly 
heavier than air, of a disgusting, rotten-egg-like character- 
istic odor. Burning with a blue name when lit in air, it 
forms sulphur dioxid gas and water. 

It is used as a group reagent to separate metals of the so- 
called second analytical group from other metals when all are 
together in solution. 

Which metal is (a) the least tenacious, (b) the most 
infusible, (c) the best for electro=magnets, (d) the best 
for electro=conductors, (e) the most rare? 

(a) Mercury; (b) osmium; (c) iron; (d) silver; (e) ra- 
dium. 

Describe the process for the preparation of nitric acid. 

Sodium nitrate and sulfuric acid are strongly heated, and 
the resultant gas passing into water, in which it dissolves, 
forming dilute nitric acid, which may be concentrated by 
heating. 

Give the flame test for barium and strontium. 

Wet a clean platinum wire with hydrochloric acid, then 
place it in a little powdered barium salt; hold the wire with 
the adherent barium salt in the inner Bunsen flame, when the 
outer flame will be colored green. 

Strontium, under like conditions, will communicate a bril- 
liant red color to the outer Bunsen flame. 



222 CHEMISTRY. 

What is the per cent, of each constituent present in 
sulfuric acid, the atomic weight of sulfur being 32? 

Hydrogen 2.04 per cent. 

Oxygen. . . ., 65.31 

Sulphur 32.65 

What are the principal constituents of milk? 

COWS' MILK. 

Water 87.41 

Solids 11.59 

Fat 3.66 

Sugar . 4.92 

Casein 3.01 

Albumen 75 

Albuminoids 3.76 

Ash 70 

To what impurity is the occasional toxic effect of bis= 
muth salts due? 

Arsenic. 

Give the chemical reason why diabetics should abstain 
from starchy foods. 

Because of the conversion of starch into glucose through 
the action of ptyalin in saliva, and of a ferment in pan- 
creatic juice. 

Glucose thus formed cannot be broken up into other sub- 
stances because of loss of power of liver cells to perform 
functions, so that this glucose passes directly into the blood, 
from which it is eliminated after being extracted through 
the action of the kidneys. 

What chemical changes take place as a result of mus- 
cular activity? 

Rapid oxidation of tissues, particularly muscular tissues. 
Increased formation and elimination of urea from decom- 
posed nitrogenous structures. Increased rapidity of circula- 



CHEMISTRY. 223 

tion brings formative material to quickly repair this loss or 
waste, so that tissues are rapidly destroyed, rapidly replaced, 
and the waste rapidly removed through exercise. 

What is the difference between fermentation and putre= 
faction? 

Fermentation is the decomposition of non-nitrogenous sub- 
stances due to the presence of a body called a ferment, which 
ferment itself contains nitrogen in its composition. 

Ordinary alcoholic fermentation is accompanied by the evo- 
lution of carbon dioxid gas. 

Putrefaction is the decomposition of nitrogenous bodies 
brought about through the presence of bacteria, and is char- 
acterized by the evolution of ammonia, and if putrefying 
substances contain sulfur, of sulfuretted hydrogen gas. 

Mention the antidotes applicable in a case of poisoning 
from iodin. 

Starch, mucilaginous drinks, flour, milk, white of egg. 

Describe chloral hydrate. 

Chloral hydrate, C 2 HC1 3 0H 2 0. 

A colorless, transparent, crystalline solid, pungent odor, 
acrid taste, soluble in water. 

Hypnotic. It liquefies if triturated with camphor, phenol, 
menthol, thymol. 

Give a chemical explanation of the souring and curdling 
of milk. 

A ferment, one of the cells of yeast, acts upon the sugar of 
milk, changing it to lactic acid, this lactic acid then produc- 
ing a sour taste and coagulating the casein. 

Name each of the following: (a) H 2 S0 2 , (b) H 2 S0 3 , (c) 
H 2 S0 4 , (d) H 2 S 2 3 . 

(a) Hyposulfurous acid; (b) sulfurous acid; (c) sulfuric 
acid; (d) thio-sulfuric acid (from which the class of salts 
known as hyposulfites are obtained). 



224 CHEMISTRY. 

What are the chemical constituents of biliary calculi? 

Cholesterine pigments, biliary acids, mucus, epithelium, car- 
bonate of calcium, fats. 

Describe your mode of procedure in making a chemical 
examination of suspected urine. 

Determine the specific gravity with urinometer. The re- 
action with Htmus paper. 

Note the color, the degree of clearness or presence of pre- 
cipitate or sediment. 

Now test for albumin. 

Fill a test-tube two-thirds full of urine and add to it suffi- 
cient saturated sodium chlorid solution to raise its specific 
gravity ten degrees. 

Add a few drops of acetic acid and boil the upper layer of 
liquid. 

Should it become less transparent it would indicate albumin. 

Then test for glucose, using Fehling's test; then deter- 
mine the relative quantity of indican by use of HC1 and of 
urophain by use of sulfuric acid. 

Then by centrifuge precipitate the chlorids with silver 
nitrate in a percentage tube, the phosphates with uranium 
acetate solution, the sulfates with barium chlorid solution. 

Then estimate urea by hypobromite of sodium solution. 

Describe the theory of the construction of the metric 
system. 

The metre, unit of linear measure, was supposed to be the 
one ten-millionth of a quadrant of a great circle of the earth. 
The metre is 39.37 inches in length. It is divided into ten 
equal parts called decimetres. 

Each decimetre is divided into ten equal parte called centi- 
metres. 

Each centimetre divided into ten parts called millimetres. 

Ten metres measure one dekametre; ten dekametres equal 
one hectometre; ten hectometres equal one kilometre. 

A cubic centimetre of distilled water, at four degrees Cent,, 



CHEMISTRY. 225 

weighs one gram, the unit of weight equaling, in the English 
system, 15.432 troy grains. 

The gram is divided and subdivided, like the metre, into 
deci-, centi-, milligrams, and we also have the multiples, deka-, 
hecto-, kilograms, referring respectively to 10, 100 and 1000 
grams. 

A cubical vessel with a length of side of one decimetre 
holds one litre of liquid, the measure of capacity. A litre 
contains 1000 cubic centimetres, and is nearly equal to the 
English quart. 

Wherein do wine, beer and whiskey differ? 

Wine containing from eight to twenty per cent, of alcohol, 
has present as well compound aromatic ethers and other vol- 
atile principles. 

Beer contains five to eight per cent, alcohol, and has much 
bitter extractive, as from hops, etc. 

Whiskey contains forty-five to fifty-five per cent, alcohol, 
possessing also aromatic substances. 

The skeleton of a man weighs 24 pounds and contains 
58 per cent, of calcium phosphate, Ca 3 (P0 4 ) 2 . Find the 
weight of phosphorus present. (Atomic weight of Ca, 40; 
of P, 31.) 

100% : 58% : : 24 lbs. : X, or 13.92 lbs. of calcium phos- 
phate. 

Calcium phosphate, molecular weight 310, contains 62 of 
phosphorus. 

310 : 62 : : 13.92 : X = 2.784 lbs. of phosphorus. Answer. 

Distinguish between physics and chemistry. 

Physics is a study treating of the changes that take place 
outside the molecule. The physical forces act between mole- 
cules. 

Chemistry as a science is a study of the changes occurring 
inside the molecule. 

Chemical forces act between atoms as well as between 
molecules. 
15 



226 CHEMISTRY. 

What is the unit of comparison in determining the spe- 
cific gravity of liquids? Of gases? 

Pure water at 4 degrees Cent., or at 60 degrees Fahr. • 
barometric pressure to be such as would support a column 
of mercury 760 millimetres, or 30 inches, in height. 

This is the standard for determining specific gravity of 
liquids. 

For specific gravity of gases we use pure dry atmospheric 
air at zero Cent, and barometric pressure 760 millimetres, or 
pure dry hydrogen at the same (standard) temperature and 
pressure. 

Define qualitative analysis and give a principal method. 

Qualitative analysis consists of splitting apart the ' con- 
stituents of a compound, and forming with each constituent 
compounds of a different character that may be readily de- 
tected by the senses. Thus qualitative analysis performed 
upon silver nitrate Separates the silver ions from the nitrions 
when to a solution of silver nitrate we add hydrochloric acid. 

And then instantly, when the silver ions are freed, they 
combine chemically with the chlorin ions of hydrochloric acid, 
forming the new body, silver chlorid, which from its insoluble 
character, its color and general appearance permit us to 
recognize its nature. 

Define (a) element, (b) compound, (c) mixture, (d) 
solution, (e) precipitate. 

(a) A substance the molecules composing it being formed 
of the same kind of atoms, (b) A substance the molecules 
forming it containing different kinds of atoms. (c) A 
mechanical mixture or union of two or more substances, 
which substances may be in any proportion and may retain 
their characteristic properties, (d) A solution is a liquid in 
which a solid substance, or a gaseous substance, has been dis- 
solved, (e) A solid substance insoluble in the liquid in which 
it forms through chemical action. 



CHEMISTRY. 227 

Which of the elements are gases at ordinary tempera- 
ture and pressure? 

Hydrogen, oxygen, nitrogen, chlorin, fluorin, argon, and a 
number of lately discovered elementary substances. 

Where do Na, Hg, Cu occur in nature? Which occur 
free? 

Copper occurs free in nature, as does also mercury, although 
but in limited quantity. Sodium occurs principally in union 
with chlorin as NaCl found in sea water, mineral springs, in 
natural water, in nearly all plant and animal structures. 

The usual form in which mercury is found in nature is in 
its combination with sulfur in the ore cinnabar, HgS. It is 
found in but few localities, as Spain, Austria, California. 

Copper often occurs free, called native copper. This is the 
case in the Lake Superior copper region. This metal is also 
found in a number of mineral combinations, as of sulfid, 
carbonate, oxid, etc. 

Describe hydrochloric acid as to its occurrence. 

We find hydrochloric acid present in certain animal fluids, 
as in gastric juice. 

It is found in a few natural mineral waters. 

It occurs in commerce under the name muriatic acid. 

How does each of the following affect litmus paper: 
(a) H 2 0, (b) H 2 S0 4 , (c) (NH) 4 OH? 

(a) No effect, (b) Turns it red. (c) Turns it blue. 

The quantity of urine being insufficient for the urino=- 
meter, how would you proceed? 

Use a small piknometer, or specific gravity flask, some of 
which are of so small a size as to be completely filled when 
containing 25 grains of water. 

Weigh the flask when filled with urine and then when 
filled with pure water. Deduct from each weighing the 
weight of the flask, then divide the weight of the urine by 
the weight of water the flask contains; or, dilute the urine 



228 CHEMISTRY. 

with an exact quantity of water, as 3 parts, 4 parts, etc., 
then use the urinometer, and from the data calculate the true 
specific gravity of the urine. 

Distinguish between starch and sugar. By what histo- 
logic element is starch converted into sugar? 

Starch is colloidal, its formula C 6 H 10 O 5 . 

It is insoluble in cold water, forms a mucilage in hot water. 
Turns iodin blue, rotates light to the right, has no sweet taste. 

Sugar is crystalline, its formula C 12 H 22 11 . 

It is soluble in cold or hot water, it rotates light to the 
left, it yields no color with iodin, it possesses a characteristic 
sweet taste. 

Starch is converted into sugar (glucose) by ptyalin. 

Complete the equation CaCl 2 + Na 2 C0 3 =. 

CaCl 2 + Na 2 C0 3 = CaC0 3 + 2NaCl. 

Mention the antidotes applicable in cases of poisoning 
from (a) oxalic acid, (b) copper sulphate. 

(a) A salt of lime or calcium — lime water. 

(b) Albumin. 

Chemical antidote is ferrocyanide of potassium. 

What is chemical decomposition? 

Chemical decomposition refers to the breaking up of a 
compound into simpler forms through chemical action. 

Give an example of a synthetic operation. 

The formation of cupric oxid by heating the metal copper 
in air or oxygen; or, mixing two parts hydrogen and one 
part oxygen by volume and heating, an explosion occurs and 
vapor of water is formed. 

What are the products of the combustion of ordinary 
coal? 

Principally carbon monoxid and carbon dioxid. 
There may also arise ammonium sulfid, ammonia, marsh 
gas, olefiant gas and acetylene gas. 



CHEMISTRY. 229 

In composition with what elements are the following 
most commonly found in nature: (a) Iron, (b) gold, (c) 
silver, (d) copper, (e) chlorin? 

(a) Oxygen or sulfur, (b) Sulfur, (c) Sulfur, tellurium 
and chlorin. (d) Sulfur, oxygen, carbon, (e) Sodium. 

Describe the production of oxygen by decomposition of 
potassium chlorate. Give the formula and equation. 

Heat potassium chlorate with or without an addition of 
manganese dioxid, and oxygen is liberated from the decom- 
position of potassium chlorate. 

2KC10 3 + heat = 2KC1 + 30 2 . 

Explain an experiment to prove that chemical action 
may be induced by electricity. 

Mix equal volumes of hydrogen and chlorin gases in a flask, 
through the sides of which pass two platinum wires that ap- 
proach near each other in the center flask. 

Connect these wires with the wires from a battery or in- 
duction coil, when on sending an electric charge the hydrogen 
and chlorin combine with explosive violence to form hydro- 
chloric acid. 

Name and describe some of the more important potas* 
sium salts. 

Potassium nitrate, crystallizing in regular cubes, is perma- 
nent in air, occurring in large quantities in the soil of hot 
countries. 

Common name is saltpetre, or nitre. 

Has a large use in arts and industries for many purposes, 
as in gunpowder and pyrotechny manufacture. 

In chemistry it is used as an oxidizing agent. 

Potassium acetate : May be obtained in crystal form by 
chemical action resulting on the addition of acetic acid to 
potassium carbonate; used in medicine as febrifuge and 
diuretic. 

Potassium carbonate: Obtained by evaporating the water 



230 CHEMISTRY. 

with which the ashes of plants have been washed (lixivi- 
ating) . 

It is a deliquescent salt. From it many salts of potassium 
may be obtained, as bi-carbonate, by passing carbon dioxid 
gas through a watery solution of carbonate of potassium. 
Potassium iodid: Made by dissolving iodin in watery solu- 
tion of potassium hydrate and evaporating and heating 
strongly, the residue dissolved in water will then yield cubical 
crystals of potassium iodid as the liquid evaporates. This 
salt is used in medicine as an alterative, to promote absorp- 
tion, and as an anti-syphilitic. 

Potassium bromid: Made by union of Br and KHO, re- 
sembles KI in crystal form and general appearance; used as 
a motor depressor to the spinal cord — a hypnotic. 

What is the formula for (a) chloroform, (b) sulfuric 
ether, (c) alcohol? 

(a) CHCI3. (b) (C 2 H 5 ) 2 0. (c) C 2 H 5 OH. 

How would you conduct an autopsy for the purpose of 
testing for arsenic in the stomach and tissues? 

The analytical chemist should be present, if possible, at the 
autopsy. Tie both pyloric and cardiac ends of the stomach 
and place this viscus, with its contents, in a glass jar that is 
chemically clean. Close the jar by a close-fitting glass stop- 
per; seal it, if possible, hermetically, and imprint a design 
upon the seal in such a way that design will be broken should 
the jar be opened. Proceed, in the same manner, to save a 
portion at least of the liver, the small intestine, portion of 
large intestine, the spleen, one kidney, the brain. 

Each of these substances are preferably kept by themselves 
in clean, well-sealed jars, so sealed that any tampering with 
contents of jar would be at once evident. 

Complete the following equations and write the name of 
each resulting compound under its formula: 

2NaCl + H 2 S0 4 = 
CaC0 3 + 2HC1 — 



CHEMISTRY. 231 

2NaCl + H 2 S0 4 = Na 2 S0 4 + 2HC1. 

Sodic sulphate Hydric chlorid. 

CaC0 3 + 2HCl=CaCl 2 + C0 2 + H 2 0. 

Calcium chlorid + Carbon dioxid -f water. 

How would you determine, chemically, whether a uri= 
nary deposit were composed of urates or phosphates? 

Heat would dissolve a precipitate of urates, but would not 
dissolve phosphates. 

A drop of nitric acid would dissolve a precipitate of phos- 
phates, but would not dissolve urates. 

What is dialysis, and how would you construct a di= 
alyzer? 

Dialysis is the process of separating crystalloids from col- 
loids when both are in the same solution. 

It is performed in a dialyzer, which consists of a glass 
vessel, the bottom of which is formed of parchment or parch- 
ment paper. We place the complex mixture in this vessel of 
the dialyzer and set the dialyzer in a larger vessel containing 
distilled water. 

In a short time the crystallizable substances will have 
passed through the animal membrane forming the bottom of 
the dialyzer into the distilled water, in which they may be 
detected, and from which they may be separated by evap- 
oration. 

The colloidal material remains in the dialyzer, not being 
able to pass through the membranous bottom. 

What is the difference between the mercurous and mer- 
curic chlorid? 

Mercurous chlorid, Hg 2 Cl 2 or 2HgCl. 

Mercuric chlorid, HgCl 2 . 

In mercurous chlorid we have chemically a molecule of 
mercury combining with two atoms of chlorin, a white im- 
palpable, insoluble powder, tasteless, odorless, turned black 
by alkaline hydrate solutions. Acts as a laxative. 

Has but slight poisonous action in single dose. 



232 CHEMISTRY. 

In mercuric chlorid we have chemically an atom of mercury 
uniting with two chlorin atoms. 

It is a white, crystalline, soluble substance, of a sweetish, 
burning, metallic taste, turning to a white mixture when 
added to lime-water, giving a yellow precipitate with alka- 
line hydrates. 

Is very poisonous; used externally as antiseptic, and in 
concentrated solutions as disinfectant. 

Administered internally in doses of -^ of a grain as a 
maximum, as an anti-specific, alterative, tonic. 

Antidote, albumin. 

What impurities may be present in sulfuric acid, and 
how would you detect them? 

Lead : Appearing when strong sulfuric acid is diluted with 
water, here giving a white precipitate or haziness to the 
mixture of sulfate of lead. 

Arsenic: Recognized by Marsh's test, using chemically 
pure zinc for the work. 

Selenic acid: Showing its presence by communicating to 
the sulfuric acid a power of dissolving gold. 

Nitric acid, or oxid of nitrogen: Detected by testing the 
suspected dilute sulfuric acid by adding to it a mixture of 
strong sulfuric acid and carbolic acid, and evaporating these 
three substances in a porcelain dish to dryness, when on heat- 
ing slightly, should nitrates or nitric acid be present, a pink 
coloration is observed. 

Organic matter in sulfuric acid causes a darkening of tint 
even to the production of a black liquid. 

What is sulfuric ether, and what is its action upon man? 

It is the oxid of ethyl, (C 2 H 5 ) 2 0, receiving its name from 
the fact that it is obtained by distilling a mixture of alcohol 
and sulfuric acid. It is a colorless liquid, lighter than water, 
readily vaporizing at ordinary temperatures, its vapor being 
heavier than air and of a characteristic odor. Ether pro- 
duces in man, or other animals that inhale it, unconsciousness, 



CHEMISTBY. 233 

muscular relaxation, and may occasion death, through a cen- 
tric paralysis of respiration. 

How would you detect the presence of bile in the urine? 

Place urine in test-tube, down which pour fuming nitric 
acid (a mixture of nitric and nitrous acids) so that acid 
collects below urine, when, at point of contact, should bile 
be present, a band of coagulation will appear of a greenish 
color; or, 

Add cane-sugar to urine, and to a drop or two of this mix- 
ture placed on white porcelain surface, add a drop of strong 
sulfuric acid, when, should bile be present, there will appear 
a play of colors forming in concentric rings, the colors par- 
ticularly prominent, being yellow, red and green. 

Give a reliable quantitative test for albumin. 

Weigh out 100 grains of urine, to it add acetic acid to 
assure its acidity, boil, cool and filter through a weighed filter 
paper, wash the coagulated material on filter paper with: 

1st. Boiling water containing a few drops of acetic acid. 

2d. "With ether. 

3d. With alcohol. 

4th. Again with boiling acidified water. 

Then dry in drying oven, temperature of which is not 
higher than 212° F., when weigh on filter paper, and when 
weight remains constant between any two successive weigh- 
ings made at intervals of half hour ; deduct from this weight, 
weight of filter paper, and result gives in grains weight of 
albumin in a hundred grains of urine. 

We wash coagulum with water to remove entangled salts, 
with ether to remove fats or oils, with alcohol to remove color- 
ing matters, resinous substances, etc. 

What is mucin? How would you recognize it in urine? 

Mucin is a compound proteid, and is composed of a proteid 
and a carbohydrate. It will reduce Fehling's solution. It 
occurs in cement substance of connective and epithelial tis- 
sues ; also present in bile and in secretions of mucous surfaces. 



234 CHEMISTRY. 

Test: It is not precipitated from urine by boiling, but is 
precipitated on the addition to urine of either alcohol, dilute 
mineral acids, acetic, picric or citric acids. To detect it add 
acetic acid to form a layer below urine without heating, when 
at point of contact a poorly denned line of filamentous-like 
deposit will appear. 

Describe the usual method of determining chemically 
the presence of blood in the urine. 

To urine add a few drops of tr. guaiacum and then an 
excess of ozonized ether, shake, the ether separates and be- 
comes of a fine sapphire-blue should blood have been present 
in the urine. 

Give a reliable quantitative test for sugar in the urine. 

Select two bottles of about six ounces capacity; in each 
bottle place four ounces of urine, adding to one of the bottles 
a small fragment of yeast. Stopper the bottles loosely and 
place in a warm place, allowing them to remain undisturbed 
for from 12 to 24 hours. Then take the specific gravity of 
the urine in each bottle, and should the specific gravity be 
less in the specimen to which yeast was added it would indicate 
the presence of glucose, which undergoing decomposition into 
alcohol and carbonic acid gas, through the action of yeast, 
will have occasioned a lower specific gravity. Each degree of 
specific gravity thus lost would correspond to the presence 
of one grain of glucose in every ounce of urine. 

What is alcohol, and how is it formed? 

Alcohol is a hydrate of an alcohol radical ; or an alcohol is 
a water in which one hydrogen atom in each molecule of water 
has been replaced by an alcohol radical. Alcohol is formed 
through that variety of chemical decomposition known as fer- 
mentation. Alcohol is obtained by distilling the results of 
the fermentation of sugary liquids. 

How is uric acid recognized chemically? 

Uric acid is recognized chemically by its precipitation from 



CHEMISTRY. 235 

urine on the addition of hydrochloric acid. Uric acid thus 
obtained may be washed, dried and weighed. 

A test for uric acid: Concentrate by evaporation a few 
drops of urine, add a few drops of nitric acid, heat until dry, 
when a pink color develops on the sides of the dish ; now add 
potassium hydrate, or ammonium hydrate, when a blue to 
purplish color is produced on further heating. This test is 
known as the murexid test for detecting uric acid. 

Name the antidotes in a case of stramonium poisoning. 

Tannic acid, strong infusions of coffee, morphin, physo- 
stigmin, pilocarpin. 

What is the principal pigment in normal urine? 

Urobilin. 

Give two chemical tests that you would use in water 
supposed to be contaminated by sewage. 

(a) Distil the water until free from ammonia, then acid 
acid permanganate of potassium solution to the residue and 
again distil, when should ammonia appear in the distillate, 
as shown by the action upon it of Nessler's solution, it would 
indicate the presence of organic matter in the water exam- 
ined. 

(b) Estimate the chlorids in the specimen of water, using 
a standard solution of silver nitrate with potassium chromate 
as an indicator. If it were found that the water contained 
an excessive quantity of chlorids it would point strongly to 
the presence of sewage in such water. 

Give tests for the purity of chloroform. 

Test for chlorin : Drop the suspected chloroform through a 
watery solution of potassium iodid in a test-tube. Should 
the chloroform, which collects at the bottom of the tube, 
acquire a pink color, and the supernatant liquid become 
yellow or brownish in tint, it indicates the presence of free 
chlorin. 

Test for HC1 : Shake the chloroform with water, and after 



236 CHEMISTRY. 

separating pour the water into a clean tube, and rendering 
it acid with a drop of nitric acid, add silver nitrate solution, 
when should hydrochloric acid or chlorids be present a white 
precipitate will form. 

Test for hydrocarbons : Evaporate suspected chloroform on 
clean porcelain surface, when no residue should be left, nor 
should there be any odor save that of chloroform only. 

Test for minute quantities of water : Add to the chloroform 
white anhydrous copper sulfate, when should the copper sul- 
fate become blue in color the presence of water would be 
indicated. 

Test for acidity: By shaking the chloroform with water, 
pouring off the water and testing it with a drop or two of 
litmus solution, when a red tint developed would indicate 
free acid. 

Explain the process of bleaching with chlorin. 

Chlorin only bleaches organic colors in the presence of 
moisture. Chlorin unites with the hydrogen of moisture, 
setting the oxygen free to produce the loss of color. In 
bleaching with chlorin we make use of a mixture of chlori- 
nated lime and water. The fabric to be bleached is first 
" soured" by passing it through a very dilute acid solution. 
It is then placed in the mixture of bleaching salt and water, 
after which it is to be thoroughly washed with proper re- 
agents to remove any excess of acid, chlorin or lime. 

State the most common and convenient antidotes for 
poisoning by mineral acids. State also the course to be 
pursued when the poison to be antidoted is unknown. 

Convenient antidotes for poisoning by mineral acids are: 
Calcined magnesia, alkaline carbonates, as baking soda, chalk, 
soap. Then use oils, fats, milk, flour, eggs. 

If poison be of unknown character administer an emetic, 
as mustard and water, or use stomach pump or syphon tube. 
If reason to suspect poison to be of alkaloidal nature give 
tannic acid or permanganate of potassium. 



CHEMISTRY. 237 

Use ammonia, whiskey or strong coffee as stimulants, and 
meet symptoms as they arise. 

How would you make Fehling's solution? 

Dissolve 173 grams of crystallized Rochelle salts in about 
500 cubic centimeters of a sodium hydroxid solution of a 
density of 1.14; call this solution No. 1. 

Dissolve 34.64 grams of crystallized copper sulfate in 
about 450 cubic centimeters of distilled water; call this solu- 
tion No. 2. 

Slowly add No. 2 to No. 1, stirring well and keeping the 
mixture in perfect solution. When mixed add sufficient dis- 
tilled water to make the completed Fehling's solution measure 
1000 cubic centimeters. 

Each cubic centimeter of this solution should have its color 
discharged by .005 grams of glucose. 

If, on boiling Fehling's solution, any change in its color 
takes place, it has spoiled and is no longer fit for use. 

What element composes over half the matter of the 
earth? 

Oxygen. 

What is oxidation? 

Chemical union of elementary bodies with oxygen; break- 
ing up of a compound substance, the elements of which 
combine with oxygen; rapid oxidation, if accompanied by 
heat and light, is called active combustion or burning. 

What is ozone? 

Electrified oxygen, each molecule of which consists of three 
atoms of oxygen ; also called allotropic oxygen. It is a blue 
gas of high chemical (oxidizing) powers, irrespirable except 
when extremely diluted, when it acts as a stimulant. 

What is Paris green? 

A double salt of copper arsenite and copper acetate. 
Cu(C 2 H 3 2 ) 2 :3Cu0 4 As 2 . 

Schweinfurt's green, Mitis green. 



238 CHEMISTRY. 

An insoluble green crystallizable powder. 

What is the chemical name of Rochelle salts? 

Bi-tartrate of sodium and potassium, KNaC 4 H 4 6 . 

What is the chemical designation of the ordinary alcohol 
of commerce? 

Ethylic alcohol, or the hydroxid of ethyl. 
From what substances is ether obtained? 
Ether results from distilling sulfuric acid and ethylic 
alcohol. 

Name the various states in which matter may exist. 
Solid, liquid, gaseous, and Crookes or radiant state. 

What is the difference between atomic weight and spe= 
cific gravity? 

Atomic weight refers (as a rule) to the density of elemen- 
tary substances compared with hydrogen as a standard. 

Specific gravity refers (as a rule) to density of either 
elementary or compound bodies compared to atmospheric air, 
if the substance examined be gaseous. Thus density of oxy- 
gen is 16, while its specific gravity is 1.1056. 

Again, the atomic weight of an elementary substance if 
multiplied by its specific heat gives a product of 6.4 or nearly 
that; while this is not always true of the specific gravity of 
an elementary substance when such specific gravity is refer- 
able to hydrogen as a standard. 

Name and describe a deliquescent salt. 

Auric tri-chlorid. A deliquescent salt is one which when 
exposed to air loses its crystal character, becoming softened, 
and finally liquefied, through its absorbing moisture from 
the air. 

Complete the following equations: 

(a) 2NH 4 Cl+Ca(HO) 2 = 

(b) 2KN0 3 + H 2 S0 4 =. 

(a) 2NH 4 C1 + Ca(HO) 2 = CaCl 2 + 2NH 3 + 2H 2 0. 

(b) 2KN0 3 + H 2 S0 4 = K 2 S0 4 + 2HN0 3 . 



CHEMISTRY. 239 

Explain the reaction which occurs when the solution of 
the two parts of a seidlitz powder are mixed. 

Seidlitz powder consists of Rochelle salts, 120 grains; sod- 
ium bi-carbonate, 40 grains; these are wrapped in the blue 
paper. 

In the white paper is placed 35 grains of tartaric acid. 

H 2 C 4 H 4 6 + 2NaHC0 3 = Na 2 C 4 H 4 6 ^2H 2 + 2C0 2 . 

To what salts do most cathartic mineral waters owe 
their virtues? 

To magnesium sulfate, or to sodium sulfate. 

Explain the construction of the safety lamp used by 
miners, and state the principle involved. 

The flame of the lamp is surrounded by a fine wire gauze, 
the mesh of which is very small. Each individual mesh con- 
tains its film of air, and as air is a poor conductor of heat, 
the heat of the burning oil is not conducted through the film 
of air in each mesh, the wire of the mesh also assisting in 
cooling the heat of combustion, so that not sufficient heat 
passes outward through the wire mesh to inflame the sur- 
rounding gas. 

What is pepsin? 

A yellowish or greyish-white powder, soluble in water and 
glycerin, but insoluble in alcohol. It gives none of the reac- 
tions of albumin. It is an enzyme, or unorganized ferment; 
it is the principal ferment found in gastric juice. Its chief 
activity is exerted upon proteid food substances, which it 
assists in converting into peptone. 

Mention the antidote applicable in case of poisoning 
from silver nitrate. 

Common table salt, NaCl. 

What is a chemical symbol? 

A chemical symbol is the initial letter of the name of an 
elementary substance, or it may consist of the initial and one 



240 CHEMISTRY. 

other important letter of the name of an elementary sub- 
stance. It is used as a short-hand designation of the element. 

What is the chemical composition of ordinary alum? 

Alum is a double sulfate of aluminum and ammonium. Its 
formula is 2NH 4 A12S0 4 , combining as 

Al 2 3SO + (NHJ 2 S0 4 = 2NH 4 A12S0 4 . 

Write the formula of (a) common salt, (b) nitric acid, 
(c) sulfuric acid, (d) hydrochloric acid, (e) carbonic an= 
hydride. 

(a) NaCl; (b) HN0 3 ; (c) H 2 S0 4 ; (d) HC1; (e) C0 2 . 

What is the simplest test of the presence of (a) an acid, 
(b) iodin? 

(a) Turns litmus paper red; (b) turns starch mucilage 
bluish-black. 

Complete the following reactions: 

CaCl 2 + Na o C0 3 = 

(C 2 H 5 )HO + C 2 H 5 HS0 4 ==. 

CaCl 2 + Na 2 C0 3 = CaC0 3 + 2NaCl. 

(C 2 H 5 )HO + C 2 H 5 HS0 4 =(C 2 H 5 ) 2 + H 2 S0 4 . 

Mention a test for ozone. Explain how ozone may be 
prepared in the laboratory, and compare its properties 
with those of oxygen. 

Gives a dark blue color to paper that has been wet with 
iodid of potassium and starch mucilage. Ozone is prepared 
by subjecting air or oxygen to silent electric discharges, as 
in the "Siemens" induction tube. 

Its properties are like those of oxygen, save that it acts 
more vigorously as an oxidizing agent. 

In concentrated form it is irrespirable. 

Name four elements that enter into the formation of 
organic bodies. 

Carbon, hydrogen, oxygen, nitrogen. 



CHEMISTRY. 241 

What preparation of gun cotton is used in medicine, 
and what is its solvent? 

That made through the action of dilute nitric and sulfuric 
acids upon chemically clean cotton. 
Its solvent is ether. 

How may uric acid be obtained from urine? 

By adding to the urine strong hydrochloric acid, when 
after the mixture has stood from 12 to 24 hours uric acid 
will appear in minute crystals. 

Mention the antidotes applicable in cases of poisoning 
from zinc chlorid. 

Albumin. 

Use emetics or stomach-pump, cold affusions to face and 
neck, inhalation of ammonia; internally administer spirits 
of ammonia, nitro-glycerine, brandy, or inject ammonia into 
the veins. 

Mention the elements that, under ordinary circum= 
stances exist as (a) liquids, (b) gases. 

(a) Bromin and mercury, (b) Oxygen, hydrogen, nitro- 
gen, chlorin, fluorin, argon. 

Give the preparation, formula, properties and uses of 
potassium cyanid. 

Potassium cyanid, KCN or KCy. Prepared by saturating 
potassium hydroxid with hydrocyanic acid. A white amor- 
phous deliquescent salt, easily fusible, and smelling of cya- 
nogen. Very soluble in water, highly poisonous, used for 
same purpose as hydrocyanic acid, used as a cardiac sedative, 
as a sedative addition to cough mixtures. It is often given 
in conjunction with an acid to form a freshly prepared hydro- 
cyanic acid. Its dose does not exceed % of a grain. 

Define valence, radical. Illustrate. 

By valence of an element or radical we refer to its numer- 
ical power by volume in which it enters into chemical union 
with other elements ; thus we say oxygen has a valence of two, 
16 



242 CHEMISTRY. 

meaning by this that one quart of oxygen would require two 
quarts of hydrogen (our standard of unity for estimating 
valence) for its perfect chemical union. 

One quart of chlorin would require but one quart of hydro- 
gen for its perfect chemical union. 

And since this power of combination is noticed in volumes 
it is inferred that ultimate subdivision of the volume, or the 
atom of the element, will possess this power of numerical 
combination distinctive with the individual atom. 

A radical is an elementary atom ; a compound radical is an 
unsatisfied or unsaturated group of atoms, as S0 4 . 

What is the formula of carbolic acid? 

C 6 H 5 OH. 

How may phosphorus be obtained? Describe the allo= 
tropic forms of phosphorus. 

Burn bones, and to the ashes add sulfuric acid and water; 
after standing 24 hours decant the liquid, evaporate it to 
dryness and heat the residue strongly; to this result add 
sand and charcoal and distil, receiving the resultant vapor 
under water, where it solidifies to yield phosphorus. 

Red phosphorus is less poisonous than the ordinary form. 
It can be obtained by heating ordinary phosphorus in an 
atmosphere of carbon dioxid. It does not dissolve in disul- 
phid of carbon. White phosphorus is noticed coating the 
stick of ordinary phosphorus that is kept under water; some 
chemists state this to be but one of the oxids of phosphorus ; 
a black allotropic form is also recognized. 

Give the formula and chemical name of each of the 
following substances, indicating those soluble in water: 
Nitre, Epsom salts, lunar caustic, Paris green, aqua fortis, 
gypsum. 

Nitre, potassic nitrate, KN0 3 , soluble. Epsom salts, mag- 
nesic sulphate, MgS0 4 , soluble. Lunar caustic, argentic 
nitrate, AgN0 3 , soluble. Aqua fortis, hydric nitrate, HN0 3 , 
soluble. Paris green, cupric aceto-arsenite, Cu(C 2 H 3 2 )o :. 



CHEMISTRY. 243 

3Cu0 4 As 2 , insoluble. Gypsum, calcic sulphate, CaS0 4 
2H 2 0, insoluble. 

What is the chemical designation of nitroglycerin? 
How is nitroglycerin manufactured? 

Glonoin, or tri-nitro-glycerin. A one per cent, alcoholic 
solution of nitroglycerin used in medicine. Nitroglycerin is 
made by cautiously mixing glycerin, strong nitric acid and 
sulfuric acid. 

What are amins? Give an example. 

They are substances which result when the hydrogen of 
ammonia is replaced by hydrocarbon radicals. 

Example : When NH 3 has one hydrogen atom replaced by 
C 2 H 5 it forms NH 2 C 2 H 5 , ethyl amin. 

Define porosity, capillary attraction. 

Porosity refers to that essential property of matter by 
virtue of which spaces called pores exist between the mole- 
cules of all substances, even the most dense. Capillary attrac- 
tion is a modification of adhesion, through which action liquids 
rise in small tubes, to which they adhere or wet ; thus through 
capillary attraction oil ascends the wick of the lamp and sap 
travels through tree structure, etc. 

How do chemical antidotes and physiologic antidotes 
differ in action? Illustrate. 

A chemical antidote seeks to form an insoluble or harmless 
substance by combining chemically with a poisonous substance 
that has been taken into the body ; thus magnesium sulfate is 
antidotal to soluble salts of lead, as it combines chemically 
with lead to form the insoluble sulfate of lead, thus to prevent 
the absorption of lead. An alkaline carbonate is antidotal 
to mineral acids, as it forms, in contact with the acids, harm- 
less salts, and destroys the power for corrosion that the acid 
possesses. A physiologic antidote acts, not directly upon the 
poisonous body, but after that poisonous substance has been 
absorbed into the blood then the physiologic antidote pro- 



244 CHEMISTRY. 

duces symptoms opposed to those which the poison occasions ; 
thus we use atropin as the physiologic antidote to morphine ; 
in its action it strongly stimulates respiration that has been 
depressed through the action of morphine. 

Mention two elements of each of the following groups: 
Univalent, bivalent, trivalent, quadrivalent. 

Univalent: Hydrogen and chlorin. 
Bivalent: Oxygen and magnesium. 
Trivalent: Arsenicum and boron. 
Quadrivalent: Silicon and platinum. 

What is the difference between analytic methods and 
synthetic methods in chemistry? 

Analytical methods seek to tear apart a compound into 
simpler bodies, as heating mercuric oxid, HgO, produces mer- 
cury and oxygen. 

Synthetic methods seek to build up a compound or complex 
body by bringing about the union of simpler bodies; thus 
we heat copper in air and form cupric oxid; we dissolve 
ammonia gas in water and thus form ammonium hydroxid, 
NH 4 H0. 

What gases are usually generated during the process of 
destructive distillation? 

If the destructive distillation be of soft coal, we find among 
the gases resulting hydrogen, marsh gas, olefiant gas, acety- 
lene gas, ammonia, sulphuretted hydrogen, carbon monoxid 
and carbon dioxid. 

Describe sulfur, and mention its important compounds. 

Sulfur is a lemon-yellow solid element. No taste or odor. 
It is strongly electro-negative, is non-metallic, resembles oxy- 
gen in its chemical combinations. It is insoluble in water, 
slightly soluble in hot alcohol, freely soluble in bi-sulfid of 
carbon. 

Its valency is 2, 4 and 6. Specific gravity compared with 
water is 2 ; specific heat .2. It crystallizes in octahedrons 



CHEMISTRY. 245 

and in right rhombic prisms. It exists in several forms. Its 
compounds are : Many important ores of a binary character, 
as zinc blend, ZnS, cinnabar, HgS, iron pyrites, FeS 2 , galena, 
PbS; also in hydrogen sulfid, H 2 S. It occurs in ternary 
compounds, in natural substances, as Epsom salt, MgS0 4 , 
Glauber's salt, Na 2 S0 4 , in gypsum or calcium sulfate, in 
heavy spar or barium sulfate. Its important compounds are 
sulfuric acid, sulfurous acid, Nordhauesen, fuming sulfuric 
acid, carbon di-sulfid, ammonium sulfid.. Many salts, as sul- 
fates of the metals. 

What is boron? Give its principal compounds. What 
is the chemical importance of boron in medicine? 

Boron is a brownish or greyish-black, solid, non-metallic 
element. Its principal compounds are boric acid and borax. 
Of boric acid, H 3 B0 3 , we have several modifications, as 
meta-boric acid and pyro-boric acid. An important salt of 
boron is sodium pyro-borate, Na 2 B 4 7 , known chemically also 
as sodium bi-borate, commonly called borax. Boron is only 
of importance in medicine from its two compounds, boric acid 
and borax, both of which are antiseptic, mildly astringent 
and detergent. 

Describe the incandescent electric light, and explain its 
use as an aid to diagnosis in medical and surgical practice. 

The incandescent electric light consists of a thin glass 
flask exhausted of air and containing a filament of carbon or 
platinum wire coiled in semicircle or other design, and when 
a current of electricity is caused to traverse this filament the 
resistance it offers to the passage of the current renders the 
filament incandescent, thus giving rise to light. 

The incandescent electric light has a considerable use in 
medicine and surgery for illuminating passages which can- 
not be directly lighted; thus we use it in the larynx as an 
aid to diagnosis; in the form of the endoscope it is used in 
the bladder. It is used also to illuminate the interior of the 
stomach, thus facilitating in the detection of hard accretions, 



246 CHEMISTRY. 

as from tumors, which would give from the outside, under 
these conditions, a shadow effect. 

Give the composition and properties of chloroform. 

Chloroform, CHC1 3 , is obtained by distilling bleaching 
salt of lime and alcohol. It is a colorless, heavy liquid. Its 
specific gravity about 1.5, is of sweet taste, also hot, and has 
a characteristic aromatic odor. It is soluble in alcohol, but 
does not mix to any extent with water, although a minute 
quantity of water may unite with it. 

It burns with a green flame. Its vapor is heavier than air. 
It is used for producing general anesthesia. It is a good 
solvent, particularly for alkaloids and rubber. 

Complete the following equation and give the resulting 
compounds: 

2C 2 H 3 K0 2 + H 2 S0 4 == 

2C 2 H 3 K0 2 + H 2 S0 4 = K 2 S0 4 + 2HC 2 H 3 2 . 

Potassic sulphate. Acetic acid. 

What organic acids are present in vegetables and fruits? 

Citric acid, malic acid, tartaric acid, oxalic acid, gallic 
acid, tannic acid, etc. 

Describe and illustrate the distinction between organic 
and inorganic compounds. 

Inorganic compounds occur in the mineral kingdom, and 
may contain any of the elementary forms of matter; the 
number of atoms in the molecule of inorganic compounds is 
usually small; they do not char when strongly heated, but 
leave a crust or residue called ash, when dried from their 
solutions. They are generally crystalline. Examples: Sod- 
ium chlorid, magnesium sulfate, etc. 

Organic compounds all contain carbon, and all except cya- 
nogen contain hydrogen. With these two elements a few other 
elements may be in union, among which we have, as most 
important, oxygen, nitrogen, sulfur, phosphorus. Often the 
number of atoms in each molecule of organic compound is 



CHEMISTRY. 247 

large, though the kinds of atoms be but few; they all char 
when heated strongly, and burn entirely away on continued 
heat, unless in their composition a metal be present. Ex- 
amples: Alcohol, glycerin. 

Give the chemical composition of (a) Glauber's salt, 
(b) Epsom salt. 

(a) Sodium sulfate, Na 2 S0 4 . (b) Magnesium sulfate, 
MgS0 4 . 

Into what two principal groups are elements divided? 
Mention five elements that exist uncombined in nature. 

Into metals and metalloids or non-metals. Oxygen, nitro- 
gen, sulfur, gold, silver. 

Mention the acid constituent of bile. 

Taurocholic and glycocholic acids. 

What is hemoglobin? On what does its color depend? 

It is the organic coloring principle of red blood corpuscles. 
C6ooH 96 oN 154 177 S 3 Fe. 

It forms a loose union with oxygen, whereby its formula 
shows 179 atoms of oxygen to the molecule instead of 177 
atoms, these additional two atoms of oxygen producing a dif- 
ferent shape of the corpuscle and giving rise to a bright red 
color. 

Differentiate nitrates and nitrites. Mention two com= 
pounds of each group commonly used in medicine. 

Each molecule of a nitrate contains the acidulous radical 
N0 3 , while each molecule of a. nitrite contains the acidulous 
radical N0 2 . 

Nitrates when heated with sulfuric acid give rise to nitric 
acid. 

Nitrites when heated with sulfuric acid yield red fumes of 
the oxids of nitrogen. 

Nitrates when heated alone, or with other substances, part 
readily with a portion of their oxygen. Examples of nitrates : 



248 CHEMISTRY. 

Nitrate of potassium, nitrate of ammonium. Examples of 
nitrites : Nitrite of amyl, tri-nitrite of glycerin. 

What reaction takes place when chloral hydrate is mixed 
with an alkali? Illustrate. 

There results chloroform, a metallic formate and water. 
C 2 HCl 2 OH 2 + KOH = CHC1 3 + KCH0 2 + H 2 0. 

What salt of mercury is soluble in water? Give the 
name and formula of a salt of silver used in medicine. 

Mercuric chlorid, HgCl 2 (bi-chlorid of mercury). Argen- 
tic nitrate, AgN0 3 . 

Describe the test for detecting the presence of strychnin. 

Place a crystal of the alkaloid on a watch-glass, and near 
it a fragment of bi-chromate of potassium. Cover each with 
a drop of strong sulfuric acid; after waiting a short time 
draw the two drops of acid together, and where they meet 
will appear a play of colors, in which may be clearly recog- 
nized yellow, red, purple and blue. 

What is a hydrocarbon? 

A hydrocarbon is an organic compound, the molecule of 
which consists of carbon and hydrogen atoms. 

What is the faradic current? How is it produced? 

The faradic current, called also the induced current of 
electricity, is developed when through an insulated wire 
of large sectional area a current of electricity flows that is 
alternately stopped and restored in its flow as it enters this 
coil, known as the primary coil. Surrounding the primary 
coil is a coil of insulated wire smaller in sectional area but 
much longer, and at the moment of breaking or restoring the 
electric flow into the primary coil currents of electricity are 
induced in this surrounding secondary coil. These induced 
currents are to-and-fro currents, that is, they are constantly 
changing their direction of flow; they constitute the true 
faradic currents. 



CHEMISTRY. 249 

What is synthesis? Mention three coal=tar products 
extensively used in medicine that are prepared in the 
chemical laboratory by synthesis. 

Synthesis is the act of constructing a compound or complex 
substance by bringing about the union of simpler bodies. 
Synthetical compounds used in medicine obtained from coal- 
tar include salicylic acid, phenacetin, saccharin. 

Differentiate a mass of matter, a chemical compound and 
an elementary body. 

An elementary body is a simple substance that cannot be 
reduced to any simpler form, that is, it is made up of but 
one kind of atom. A chemical compound is the resultant of 
the union of two or more elementary bodies, and it may be, 
as the molecule, infinitely small. A mass of matter is an 
aggregation of either elementary or compound molecules, but 
of sufficient size to be acted upon by molar forces. 

Explain the following terms: Chemical reaction, alka= 
line reaction. 

Chemical action refers to the union of atoms or radicals 
to form new bodies after, through chemical action, they have 
been separated from their former combinations. A substance 
is said to have an alkaline reaction if when dissolved it 
changes red litmus to blue. 

Describe some method for (a) analysis of water, (b) the 
synthesis of water. 

(a) Pass water in the form of steam through an iron pipe 
heated to redness, when the oxygen of water will enter into 
chemical union with the iron of the pipe, coating the latter 
with magnetic oxid of iron, Fe 3 4 , and hydrogen gas will 
issue from the distal end of the pipe. 

(b) Pass dry hydrogen gas over copper oxid placed in a 
hard glass tube and heat it to redness, when the hydrogen 
will enter into chemical combination with the oxygen, and 
vapor of water will issue from the distal end of the tube, 
while remaining in the tube will be the metal copper. 



250 CHEMISTRY. 

State the chemical properties of carbon. Describe two 
allotropic forms of carbon. 

Carbon is an electro-negative solid element, atomic weight 
12. Valency diad and tetrad. It is not a supporter of com- 
bustion. It combines readily with oxygen to form two oxids, 
carbon monoxid and carbon dioxid. Combines with hydro- 
gen to form many bodies known in organic chemistry as 
hydrocarbons. It forms binary combinations with most non- 
metals and with a few metal elements. It is non-poisonous. 

An allotropic form of carbon is graphite ; this is a greyish- 
black substance crystallizing in hexagonal plates. It occurs 
in large mineral deposits, and, when mined, has great use as 
a lubricant, for making crucibles and to make lead pencils. 
Diamond is another allotropic form of carbon, occurs in octa- 
hedral crystals, is colorless, of high refracting power, is hard- 
est substance known, occurs imbedded often in beds of blue 
clay, as in South African region. When burned in oxygen it 
gives rise to carbon dioxid gas. It is insoluble in all liquids. 

Mention the principal constituents of muscle. 

Water 80 

Solids 20 

Ash 126 

Albuminous 15. 

Etherial extractive 33 

Non-nitrogenous 3.25 

Glycogen 2.43 

Glycosin 71 

How is the air of an apartment tested to determine the 
presence and amount of carbon dioxid in it? 

Through the neutralizing effect of carbon dioxid upon the 
caustic strength of lime-water. 

We determine the caustic strength of lime-water in terms 
of oxalic acid solution. We next expose a measured quantity 
of lime-water to the action of a measured quantity of atmos- 



CHEMISTRY. 251 

pheric air, when the carbon dioxid in the air will neutralize 
in part the alkalinity of the lime-water. Removing this lime- 
water, so changed, we again test its alkalinity by the use of 
oxalic acid solution, using phenolphthalein as our indicator, 
when the loss of alkalinity of the lime-water expresses the 
quantity of carbon dioxid present in the volume of air we 
have tested. This is, in brief, the principle upon which Pet- 
tenkofer's test for C0 2 depends. 

Give names and formulas of the salts of iron commonly 
used in medicine. 

Ferric chlorid, Fe 2 Cl 6 ; ferric iodid, Fe 2 I 6 ; ferric sulfate, 
Fe 2 3S0 4 ; ferric acetate, Fe 2 6C 2 H 3 2 ; ferric oxid, Fe 2 3 ; fer- 
rous sulfate, FeS0 4 ; ferrous carbonate, FeC0 3 , etc. 

Mention two salts of mercury commonly used in medi= 
cine. Give their formulas. 

Mercuric chlorid, HgCl 2 . 
Mercurous chlorid, Hg 2 Cl 2 . 

What conditions favor putrefaction? What conditions 
may prevent putrefaction in dead organisms? 

Presence of moisture, warmth, though not a higher temper- 
ature than 110° F., bacteria, and a body containing nitrogen 
capable of undergoing putrefaction. Putrefaction may be 
prevented by the exclusion of bacteria or air containing the 
same, by exclusion of moisture, by the preservation of low 
temperatures at or below the freezing-point of water, and by 
the use of germicides. 

Give source, character and uses of atropin. Describe 
the symptoms of poisoning by atropin. 

Atropin is an alkaloid obtained from belladonna leaves. It 
is crystallizable and soluble in water, has a bitter taste, and is 
highly poisonous. Typical symptoms of its poisonous action 
are dilatation of pupil of eye, dryness of throat, flushing of 
face, talkative delirium; later paralysis of centric origin, 
death from paralysis of respiration. Pulse at first slow, hard ; 



252 CHEMISTRY. 

later soft and dicrotic, rapid. It is used as midriatic and as 
tonic to increase respiratory and cardiac efficiency. 

Give the properties of common alum. 

It is a white efflorescent crystalline body of a sweetish, 
somewhat metallic, styptic taste. It has heating and mildly 
caustic effects on mucous surfaces, particularly that variety 
of alum that has been heated to rapidly free it from its water 
of crystallization. It is used largely as an astringent and as 
a mechanical emetic. It is soluble in cold water, and far more 
soluble in hot water. It is used as a mordant in dyeing. 

What metallic chemical elements are found in the body 
in various combinations? 

Iron, magnesium, calcium, potassium, sodium, lithium, 
ammonium, hydrogen. 

Differentiate hydracids and oxyacids. 

A hydracid or hydrogen acid is a binary compound com- 
posed of hydrogen and a non-metallic element, as hydrochloric 
acid, HC1. An oxyacid is a ternary acid containing hydro- 
gen, oxygen and a third element usually non-metallic (may 
be a metal), as sulphuric acid, H 2 S0 4 . 

Give the chemistry of lithium. 

Occurs as chlorid in the mineral lepidolite; also occurs in 
combination as phosphates and carbonates, frequently found 
in mineral waters. Separated from its compounds, the metal 
lithium is the lightest of metals, being little more than half 
the weight of water. It closely resembles potassium and 
sodium, with which it is grouped as an alkali metal. It de- 
composes water in the cold, setting hydrogen free. It is 
strongly electro-positive, is monad in valency, it oxidizes in 
air or water; it has no commercial use as a metal. 

What is the principal source of urea in the human 
economy? 

Urea is the result of the oxidation of nitrogenized tissues, 
particularly muscular tissue. Urea represents the final 



CHEMISTRY. 253 

change of proteid foods after they have served their purpose 
in the economy. 

Give the formula of ammonium chlorid. Describe the 
method of preparing ammonium chlorid. 

Ammonium chlorid, NH 4 C1. It is prepared by saturating 
ammonium hydrate with hydrochloric acid, and evaporating 
the result and allowing crystallization to take place. 

Give the chemical name and properties of (a) cream of 
tartar, (b) plaster of Paris. 

(a) Sodium and potassium bi-tartrate, NaKC 4 H 4 6 . It is 
a crystallizable white salt, soluble in water. 

(b) Anhydrous calcium sulfate, 3CaS0 4 2H 2 0, or every 
three molecules of calcium sulfate are combined with two mole- 
cules of water. Plaster of Paris is a white impalpable pow- 
der, practically insoluble in water, but when wet it takes 
sufficient water to revert nearly, but not quite, to its origi- 
nal state of gypsum, CaS0 4 2H 2 0, and in so doing sets to a 
firm coherent mass, and through this action is of use for tak- 
ing impressions or making casts of objects. 

Give the physical and chemical properties of hydro= 
chloric acid. How is hydrochloric acid prepared? 

Hydrochloric acid is a colorless gas, but is best known com- 
mercially and chemically in the form of a solution of this gas 
in water. In this form, when pure, it occurs as a colorless 
liquid, fuming in air, with caustic and corrosive action upon 
organic tissues. Specific gravity is 1.2. 

It is a mono-basic hydrogen acid, and in union with bases 
forms salts called chlorids, which are all, save three, soluble 
in water. 

Hydrochloric acid may be prepared by heating a chlorid, 
as sodium chlorid, with sulfuric acid, and allowing the gas- 
eous HC1 so produced to pass into and dissolve in water. 

Describe Fehling's test for sugar in the urine. 

Fehling's test: Place one drachm of Fehling's solution in a 



254 CHEMISTRY. 

test- tube, heat to boiling, and note that Fehling's solution 
does not change in color, thus proving its fitness for use ; then 
add from one to five drops — not more — of the suspected urine 
and boil, when, should Fehling's solution lose its color, or a 
precipitation varying in color from yellow to dark red appear, 
glucose is present in the urine. 

The urine must be freed from albumin, should it be present, 
before performing Fehling's test. 

Complete the following reactions: 

PC1 3 + 3H 2 = 

2NaCl + MgS0 4 =. 

PCI3 + 3H 2 = H3PO3 + 3HC1. 

2NaCl + MgS0 4 = MgCl 2 + Na 2 S0 4 . 

How are the phosphates produced in the animal body? 

The phosphates often exist ready formed in plant foods, as 
in wheat. They are also found in animal structures that 
afford food for the human subject. Phosphates occurring 
naturally in soils are absorbed by the rootlets of plants and 
pass at once to the fruit or grain or seed. 

Should phosphorus in other forms find entrance into the 
human subject it would quickly undergo oxidation, the newly- 
formed oxid would become hydrated, and a combination 
through chemical double decomposition would at once produce 
a salt or phosphate from phosphoric acid. 

Give the symbol, atomic weight and the occurrence in 
nature of bismuth. 

Symbol, Bi. Atomic weight, 208.9. Occurrence chiefly in 
the metallic state, disseminated in veins through various rocks. 
It also occurs in minerals as a sulfid, and it is often found in 
rocks which contain arsenical minerals. 

Give the formulas of the nitrogen acids. How is nitro= 
gen prepared in the labratory? 

Nitrous acid, HN0 2 . Nitric acid, HN0 3 . 

Nitrogen is prepared by burning phosphorus in a confined 



CHEMISTRY. 255 

space of air, when the oxygen chemically combines with the 
phosphorus to form phosphoric and phosphorous anhydrids, 
both of which solidifying, fall to the bottom of the jar, and 
should there be water present, dissolve and enter into 
combination with the water, thus leaving the jar with nothing 
but nitrogen present. 

Give chemical name of (a) common table salt, (b) soot, 
(c) vinegar, (d) verdigris. 

(a) Sodium chlorid. (b) Carbon, (c) Dilute acetic 
acid, (d) Basic cupric acetate. 

What reaction of urine favors the deposition of uric 
acid gravel or calculi? What is the reaction of the urine 
during the formation of a phosphatic calculus? 

(a) A strongly acid reaction, (b) An alkaline reaction. 

What is nitroglycerin? Give the medical properties of 
nitroglycerin. 

Nitroglycerin is glycerin in which three hydrogen atoms 
in each molecule have been replaced by three N0 2 radicals. 
It is obtained through the action upon glycerin of a mix- 
ture of strong nitric and sulfuric acids. Its formula is 
C 3 H 5 (N0 2 ) 3 3 . 

It is used medicinally in a one per cent, alcoholic solution, 
acting as a strong, immediately acting cardiac stimulant. 

What is (a) starch, (b) dextrin? 

(a) Starch, C 6 H 10 O 5 , is a white organic carbohydrate, in- 
soluble in cold water, forming a colloidal mucilaginous mass 
in hot water. Gives a blue-black color with iodin. Polar- 
izes light to the left. 

(b) Dextrin, has the same molecular formula, and may 
be obtained by heating the stanch. It is soluble in cold water, 
has a somewhat sweetish taste, turns light to the right, and is 
a midway point in the conversion of starch into glucose. 



256 CHEMISTRY. . 

Define proteid. Give some of the physical character- 
istics of proteids. 

A proteid is an organic food principle containing C, H, 
0, N, with perhaps sulfur or phosphorus. It is found in the 
albuminous compounds occurring in both animals and plants. 
It is colloidal and insoluble* It gives an orange-red color 
when boiled with nitroso-nitric acid. Gives a red color on 
contact with sugar and sulfuric acid. 

Describe and state the uses of the thermometer, the 
barometer and the hygrometer. 

A thermometer is a capillary tube containing mercury, and 
nothing else. It is hermetically sealed ; has a bulb at the lower 
end and a graduated stem above. It is used to determine the 
degree of the intensity of heat. 

A barometer is a glass tube closed at the upper end, the 
lower end immersed in a vessel or cup of mercury. The tube 
above the level of the mercury has been made free of air ; the 
mercury extends from the cup below to a height of 30 inches 
up the tube. The barometer is used to indicate the condition 
of the air, to foretell storms; as the air becomes dry the 
column of mercury rises in the tube to 30 inches in height or 
a fraction above, while upon the occurrence of storm, water 
vapor in the air, prevents the air from supporting a column 
of mercury at this height, so the mercurial column falls. 

A hygrometer is an instrument used to measure indirectly 
the amount of moisture in the atmosphere and to determine 
the dew point of any specimen of air. It consists of two 
thermometers, the bulb of one being kept constantly wetted 
to promote evaporation, the thermometer so treated being 
known as the wet bulb thermometer, and is used to indicate 
the temperature of the dew point. 

Explain the method of producing X or Roentgen rays. 

The X or Roentgen rays are produced by passing a current 
of electricity of high potential, as from an induction coil, 
through a glass tube that has been, as far as possible, ex- 
hausted of air. 






CHEMISTRY. 257 

(a) Express in cubic centimeters of distilled water the 
value of one ounce avoirdupois, (b) How many minims 
does a cubic centimetre contain? 

(a) About 30 cubic centimetres. 

(b) About 15% minims. 

What is hydrogen sulfid? Show by formulas and equa- 
tion how it is obtained by the action of hydrochloric acid 
on calcium sulfid. 

It is a colorless gas of highly offensive odor and poisonous' 
effects. It burns in air with a blue flame to form sulfur 
dioxid and water. It is slightly heavier than air, and is solu- 
ble in water. 

CaS + 2HC1 = CaCl 2 + H 2 S. 

What salts form the tartar deposited on the teeth? 
From what source is the tartar derived? 

Calcium phosphate, calcium carbonate, bacteria, organic 
matter, salts of the alkalies, and silica. The tartar comes from 
an alkaline saliva. 

What are the properties of antimony? How is it found 
in nature? 

Antimony is a white, highly crystalline metal with a slight 
bluish tint. It volatilizes when heated, forming Sb 2 3 when 
burned in air. 

When powdered it takes fire if dropped in chlorin gas, 
forming a chlorid of antimony. In alloys it increases hard- 
ness, lowers fusion point, gives smoother surface, causes ex- 
pansion of alloy when cooled after fusion, gives rigidity to 
soft metals. It is found native ; it is also found in connection 
with certain metallic ores, as of zinc and copper ; it sometimes 
occurs as sulfid of antimony. 

(a) What is an amorphous substance? (b) What are 
isomorphous substances? 

(a) A dry substance, not occurring in crystalline form. 
17 



258 CHEMISTRY. 

(b) Such as although being of the same percentage compo- 
sition of elements yet show entirely different properties. 

Give uses of the urinometer. State its importance as 
an aid to diagnosis. 

It is used to determine the specific gravity of the urine. 
It is useful in indicating the necessity, or otherwise, for per- 
forming further and more exact tests upon the urine under 
examination. Should the urine vary in its specific gravity 
below 1015 or above 1025, it would at once indicate the abso- 
lute necessity for examining such urine to determine the 
presence or absence of albumin in the first place and glucose 
in the second place. Its record of a high specific gravity in 
the absence of the glucose gives many indications for the 
prescribing of diet and regimen in cases of disease. 

Describe potassium. Give the names of the principal 
salts of potassium used in medicine. 

It is a silver- white metal, nearly as soft as wax, decomposing 
water in the cold with liberation of hydrogen gas. It oxidizes 
in air and in moisture. When heated to incandescence it 
produces a rose-red, slightly bluish color. The color of its 
vapor is green; it melts below boiling point of water; it is 
lighter than water ; it is one of the strongest of electro-positive 
elements. It is a metal, and is of monad valency. It com- 
bines with the non-metallic elements. Its salts useful in 
medicine include the acetate, citrate, nitrate, chlorate, chlo- 
rid, bromiid, iodid, hydrate, sulfate, and carbonate of potas- 
sium. 

Write a chemical equation showing a double decompo= 
sition. 

AgN0 3 + HC1 = AgCl + HN0 3 . 

Give the physical and chemical properties of mercury. 
How is mercury obtained from the native ore? 

Mercury is a silver-white liquid metal 13% times heavier 
than water; it is volatile at all temperatures, opaque, insolu- 
ble in water, soluble in nitric acid. Chemically, it is electro- 



CHEMISTRY. 259 

positive, and capable of forming two distinct classes of com- 
pounds ; in one of these classes it is thought the molecule of 
mercury combines with other elements or radicals in a diad 
capacity. Such combinations are but slightly poisonous to 
the human subject. 

Another series of compounds represent the atom of mer- 
cury combining as a diad with other elements or radicals and 
forming highly poisonous, very active and unstable com- 
pounds. Mercury is obtained from its principal ore, cinnabar, 
by heating the ore and cooling the resulting vapor of mercury 
and allowing of its deposition in earthenware receivers. 

Define decay. 

Decay refers, generally, to slow oxidation, causing the 
decomposition or organic substances. The results of de- 
cay favor the union of each element in the substance with 
oxygen. 

Describe distillation, filtration and precipitation as ap= 
plied to processes for purifying drinking water. 

It is impossible to distil water for very 'many individuals, 
so that this process of purifying is inadmissible for city or 
town. It, however, affords one of the best means at the 
householder 's command for purifying water. After distilling 
the water, to fit it for use, it should be aerated by having it 
fall in cascade, in the air, from one vessel to a second ono 
several feet below. 

In filtration the impure water passes through a collection 
of stone, gravel and fine sand, and not only are 'the suspended 
matters removed from such water, but through the action of 
bacteria many organic substances dissolved in the water are 
oxidized and rendered harmless, this action occurring through 
the influence of bacteria settled upon and growing in the 
filtering medium. In precipitation, as applied to purifying 
water, the simplest method is to add alum in not larger quan- 
tity than six grains to the gallon of water. 

The action here is a chemical one, the alum forming a bulky 



260 CHEMISTRY. 

hydrate with organic matter present, and this hydrate en- 
tangling and carrying down suspended matters, so leaving 
the water clear. 

What is freezing? State the Fahrenheit freezing point 
of (a) water, (b) alcohol, (c) mercury. 

Freezing or congealing is the name given to the change of 
a liquid to a solid upon the lowering of temperature. 

In this act the molecules are packed closer together, limiting 
their freedom of movement. 

Freezing point of water, 32 degrees Fahr. 

Freezing point of mercury, — 39.4 degrees Fahr. 

Freezing point of alcohol, — 202 degrees Fahr. (absolute). 

Complete the following equation: 

C 2 H 5 OH + NaC 2 H 3 2 + H 2 SO, = 

C 2 H 5 OH + NaC 2 H 3 2 + H 2 SO, = C 2 H 5 C 2 H 3 2 + NaHS0 4 + H 2 
Explain the difference between a sulfate and a sulfite. 

A sulfate is a salt, each molecule of which contains the 
acidulous radical S0 4 . 

A sulfite is a salt, each molecule of which contains the 
ajcidulous radical S0 3 . 

It will therefore be seen that a sulfate differs from a sulfite 
in containing one more atom of oxygen in each molecule. 

Name the elements in the potassium group, and give 
their physical and chemical properties. 

Sodium, potassium, lithium, caesium, rubidium, also the 
electro-positive radical ammonium. 

Excepting ammonium, they are all white metals, the softest 
being but little harder than wax. They melt below the boiling 
point of water, oxidize in air, decompose water, liberating 
hydrogen. All are strongly electro-positive, forming strong 
alkaline bases— oxids and hydrates. Each communicates a 
distinctive color to flame when incandescent. All are of 
monad valency, their carbonates all vaporizing unchanged 
when heated. Carbonates and phosphates of these metals are 
freely soluble in water. 



CHEMISTRY. 261 

Describe the element silver, stating its compounds and 
their uses in medicine. 

Silver, a pure white metal, the best conductor of heat and 
electricity. It is the second metal in order of malleability. 
In tenacity it occupies fourth rank. Specific gravity 10.4. 
Ductility second rank. It melts at 1040 Cent., or 1904 Fahr. 
Its atomic weight is 107.7. 

It is used as pure silver wire in surgery. Silver nitrate, 
AgN0 3 , when pure and crystallized is used internally as an 
astringent and alterative. In solution it is locally applied as 
a stimulant or caustic. 

The impure silver nitrate is melted and moulded in sticks 
then known as lunar caustic ; has large use in surgery. Oxid 
of silver, Ag 2 0, is used in pill form, internally, as an alter- 
ative and astringent. 

Name five compounds of nitrogen and oxygen, and give 
their formulas. 

Nitrous oxid, N 2 0; nitric oxid, NO; nitrous anhydrid, 
N 2 3 ; and nitric anhydrid, N 2 5 ; nitric peroxid, N0 2 . 

What is the presumption as to abnormal constituents in 
urine having a specific gravity of 1005 or less? What 
tests should be applied, and how, to verify the surmise? 

It indicates a greatly decreased excretion of solids by the 
kidneys; this may be due to lack of nervous control over 
excretory function of kidney, as in hysteria, chorea, at crisis 
of acute diseases, etc. 

It may be a polyuria, arising from certain nervous diseases 
or from large imbibition of fluids or watery foods. It may 
be due to such diseased conditions of kidney that have led to 
destructive changes in structure, rendering the kidneys un- 
able to properly excrete solids that should be present in 
urine. Such a low specific gravity always calls for a careful 
examination for albumin, which, if found present, would indi- 
cate a structural disease of the kidneys, if accompanied by 
urinary pasts, as seen under the microscope. Tests for albu- 
min have been given. 



262 CHEMISTRY. 

What are the differences between common alcohol and 
absolute alcohol? 

Absolute alcohol Common alcohol 

Not more than 1 per cent, water. About 9 per cent, water. 

Specific gravity .797. Specific gravity .820. 

Complete the following equations: 

C 2 H 5 C1 + AgHO = 
CaC0 3 + 2HCl=. 

C 2 H 5 C1 + AgHO = AgCl + C 2 H 5 OH. 
CaC0 3 + 2HC1 = CaCl 2 + H 2 + C0 2 . 

What are the physical and chemical properties of S0 2 ? 

It is a colorless gas, dissolving and chemically combining 
with water to form sulfurous acid. It has a suffocating, 
irrespirable odor, can be liquefied and solidified ; when lique- 
fied it produces on its evaporation very low temperatures in 
surrounding objects. S0 2 has a molecular weight of 64, and 
is more than twice the weight of air. It will not support 
combustion nor will it burn. It has a powerful affinity for 
moisture, to form by its union sulfurous acid, and this acid, 
slowly absorbing oxygen from air, changes to sulfuric acid. 
Sulfur dioxid is useful as a bleaching agent, as a disinfectant, 
and for the purpose of destroying ferments or limiting fer- 
mentation. It is a strongly acid anhydrid. 

What is reduced iron (ferrum redactum), and how is it 
obtained? 

It is a chemically pure form of iron occurring in fine pow- 
dery condition. It is obtained by heating ferric oxid to red- 
ness in a hard glass tube, and, while hot, passing through the 
tube dry hydrogen gas, which combines with and removes the 
oxygen, leaving reduced iron in the tube. 

Describe ethyl oxid, giving derivation, ordinary name, 
chemical formula and mode of production. 

Ethyl oxid or ordinary sulfuric ether, or ether, (C 2 H 5 ) 2 0, 
is obtained by the replacement of two hydrogen atoms in a 



CHEMISTRY. 263 

molecule of water by two ethyl radicals. It is manufactured, 
by distilling a mixture of grain alcohol and sulfuric acid. 

C 2 H 5 OH + H 2 S0 4 = C 2 H 5 HS0 4 + H 2 ; 

Then C 2 H 5 HS0 4 + C 2 H 5 OH =(C 2 H 5 ) 2 + H 2 SO,. 

What is the presumption as to abnormal constituents in 
urine having a specific gravity of 1038? 

Such urine will probably be found to contain glucose. 

Give an equation showing the reaction when NH 3 comes 
in contact with an acid. 

NH 3 + HC1 = NH 4 C1. 

What is the chemical treatment of esophageal and stom- 
ach corrosion from mineral acids? Give an argument 
against the use of the stomach=pump in such cases. 

Use oxid of magnesium. Then albumin or oils. 

In such cases the tissues have been so thinned out through 
corrosion that an implement introduced, as a tube from a 
stomach pump, may cause perforation of the denuded tissues 
with fatal results. 

Define emulsion, soap. 

An emulsion is a liquid holding in suspension oil in very 
finely divided condition, so that the individual drops are 
invisible to the naked eye. There is generally present a sub- 
stance of mucilaginous nature to attain this result. 

A soap is a metallic salt of a fat acid. It is usually a 
potassium or sodium salt of oleic, stearic or margaric acid. 

Give the sources and explain the uses of benzene. 

C 6 H 6 , benzene. It is found in the lighter oils from the 
distillation of coal tar. 

It is a solvent for fats, oils, resins, and many other organic 
substances. 

It is used as a cleansing agent and solvent. 

What is an alkaloid? Name three alkaloids used in 
medicine. 

An organic base which always contains nitrogen, posses- 



264 CHEMISTRY. 

sing, of course, an alkaline reaction when in solution. It is 
generally of a crystallizable nature, and forms salts with 
acids. The alkaloids of vegetable drugs generally possess the 
activity of the drug substance. Strychnin from nux vomica, 
quinin from cinchona bark, and morphin from opium (dried 
juice of the poppy) are alkaloids of frequent use in medicines. 

State the chemical meaning of the term incompatible. 

Chemically, substances are incompatible when on mixing 
their solutions an insoluble body results, or a new substance 
having markedly different properties results, or when two 
or more substances, in themselves harmless, form a poisonous, 
explosive or inflammable substance when brought in contact; 
or bodies are incompatible if bringing them together impairs 
their individual characteristic properties. 

State the use and the principle underlying the use of the 
bIow=pipe. 

The blow-pipe serves to provide a jet of flame of extremely 
high temperature, and of complete combustion, through the 
mixing of air with gas before the latter burns. 

The blow-pipe serves to concentrate at a particular point 
very high temperature. 

Define electricity. 

Electricity is that physical force which manifests itself by 
producing attraction or repulsion between certain substances, 
and gives rise to heat, light, magnetism, chemical action and 
explosive or disruptive effects. 

(a) In what compound is sodium most abundant? (b) 
In what calcium? (c) In what hydrogen? 

(a) Sodium chlorid. (b) Calcium carbonate, (c) Water. 
What is glycerin, and how is it obtained? 

Glycerin, C 3 H 8 3 or C 3 H 5 30H. It is a tri-atomic alcohol 
of the third series of hydrocarbons, of which the first member 
is C 3 H 8 , or propane. When three hydrogen atoms of propane 
are replaced by three hydroxyl radicals, glycerin results. 



CHEMISTRY. 265 

Glycerin may be obtained by passing superheated steam 
through fats, which brings about a separation of the fat into 
glycerin and a fat acid. Glycerin also results in soap-making. 

Explain the difference between a galvanic and a faradic 
current. 

A galvanic current results from chemical action, and has 
but low potential with large quantity. Its direction of flow 
is always the same. A faradic current results from induction 
of a current into a coil of insulated wire that surrounds a 
shorter coil of larger wire, through which a galvanic current 
alternately flows, or is cut off from flowing. Such a faradic 
current possesses high potential, small quantity, and its 
direction of flow is to and fro, or alternating. 

What products of phenol are of interest in medicine? 

From phenol (carbolic acid, C 6 H 5 OH) we have coal tar 
creosote, the sulpho-carbolates, as of sodium, zinc, etc. 
Phenol-sulphonic acid, salol. 

Designate the following as chemical or physical changes: 

(a) The souring of milk. 

(b) Decomposition of sunlight by means of prisms. 

(c) Converting water into steam. 

(d) Dissolving salt in water. 

(e) Decay of wood. 

(a) Chemical; (b) physical; (c) physical; (d) physical; 
(e) chemical. 

Mention the chief properties of nitrogen. 

In its molecular form nitrogen is a very inert substance. 
Its properties are negative ones; thus it will not burn, will 
not support combustion, has no color, odor or taste. It is 
slightly lighter than air. Symbol, N. Atomic weight, 14. 
It will unite directly with heated magnesium. It may enter 
into chemical union under favoring conditions with hydrogen, 
with oxygen, and with a few other of the non-metals. 

When nitrogen is in combination with other elements its 



266 CHEMISTRY. 

atom gives great activity to the compounds. Thus it forms 
with hydrogen a very strong alkaline gas; with C, H and 0, 
nitrogen gives rise to extremely poisonous bodies — the alka- 
loids — to highly explosive bodies, as gun cotton; to food ele- 
ments of great nutritive value, the proteids, etc. 

What metal is liquid at ordinary temperature? 

Mercury. 

Mention a substance containing albumin, (a) as a liquid, 
(b) as a solid. 

(a) Milk, (b) Flour. 

What is the chemical cause of spontaneous combustion? 

May be active oxidation, as would occur were finely divided 
phosphorus exposed to air (oxygen). 

May be from direct chemical union of an intense activity, 
as would take place were phosphorus brought in contact with 
iodin or bromin. 

It may be due to dehydration of substances, as by the 
action of strong sulfuric acid on wood or paper, or through 
the action of quicklime combining with moisture. 

Describe a test for the presence of organic matter in 
water. 

Having distilled water until free from ammonia, we add to 
the residue in the retort an acid solution of permanganate of 
potassium, when if, on again distilling, ammonia appears in 
the distillate, it would indicate the presence of organic matter 
in the water that had undergone conversion into ammonia 
through the action of the permanganate solution. 

This ammonia in the distillate may be recognized by the 
use of Nessler's solution. 

Give the names and formulas of five acids used in medi- 
cine. 

Nitric acid, HN0 3 ; sulfuric acid, H 2 S0 4 ; muriatic acid, 
HC1; ortho-phosphoric acid, H 3 P0 4 ; acetic acid, HC 2 H 8 2 . 



CHEMISTRY. 267 

Mention the elements existing uncombined in nature. 

Hydrogen, oxygen, nitrogen, carbon, sulfur, gold, silver, 
platinum, copper, mercury, and a few other metals. 

What is carbon dioxid? Give its formula, properties, 
uses and mode of production. 

It is a gas without color, odor or taste, being about one and 
a half times the weight of air. It does not support combus- 
tion nor animal respiration. It will not burn, it is soluble 
in water. It may be liquefied and solidified. The liquid 
allowed to evaporate occasions very low temperatures in sur- 
rounding objects. Its formula is C0 2 . It is often held in 
water under pressure, and on the pressure being relieved the 
carbon dioxid gas escapes through the liquid, producing bub- 
bling (effervescence). 

We find this to constitute the ordinary soda water. Dis- 
solved in water, carbon dioxid adds piquancy to the taste of 
water, 'and it exerts a sedative effect upon an irritated or 
inflamed mucous lining of the stomach. Its presence in water 
increases the solvent power of water. 

It can be prepared through the action of an acid, as sulfuric 
acid, upon a carbonate, as marble dust. 

CaC0 3 + H 2 S0 4 = CaSO, + H 2 + C0 2 . 

When and why is a flame produced by combustion? 

When in the gas we have present solid matter in a finely 
divided form. 

The heat of the flame rendering this solid matter incan- 
descent, gives rise to flame. 

Give the preparation of Fowler's solution, and describe 
the salts contained in it. 

Dissolve one part arsenious anhydrid and two parts potas- 
sium bi-carbonate in 94 parts water and add three parts 
compound tincture of lavender. 

The solution so made contains potassium met-arsenite. 

As 2 3 + 2KHCO a = 2KAs0 2 + H 2 + 2C0 2 . (Simon.) 



268 CHEMISTRY. 

What is chloroform, and how is it made? 

It is the tri-chlorid of methane, CHC1 3 . 

It is a colorless liquid, specific gravity of 1.5 ; it has a char- 
acteristic aromatic odor and a sweet burning taste. It is 
capable of producing general anesthesia when inhaled. It is 
a valuable solvent for a number of substances, as alkaloids, 
rubber, etc. It is made by distilling the bleaching salt of 
lime with alcohol and purifying the result. 

Describe and illustrate alcoholic fermentation. 

Alcoholic fermentation is the decomposition of sugary 
liquids brought about through the presence of a ferment, 
the yeast plant, and attended by the change of glucose into 
alcohol and carbonic oxid gas. 

C 6 H 12 6 = 2C0 2 + 2C 2 H 5 OH. 

What is ethyl hydrate? Give its formula, and state 
how it is produced. 

Ethyl hydrate, C 2 H 5 OII, is ordinary grain alcohol. It 
results from fermentation of sugary liquids, and is separated 
from water and other matters by subsequent distillation. 

Complete the following equations: 

2NaCl + Ag 2 S0 4 = 

Ba0 2 + C0 2 + H 2 = 

2NaCl + Ag 2 S0 4 = 2AgCl + Na 2 S0 4 

Argentic chlorid -|- Sodic sulphate. 

Ba0 2 + C0 2 + H 2 = BaC0 3 + H 2 2 

Baric , Hydric 
carbonate ~*~ peroxid. 

Define matter. 

Matter refers to anything that has weight and occupies 
space. 

Define and illustrate osmose. 

Osmose refers to the intermingling or mixing of liquids of 
different densities when separated by porous partitions; thus 
if a cupric sulfate solution be placed in a jar of porous 



CHEMISTRY. 269 

earthenware, and this jar be set in a larger vessel containing 
distilled water, we would soon find sulfate of copper present 
in the outer jar that contained water, while the jar contain- 
ing sulfate of copper would be weakened through the passing 
inward from the outer vessel of distilled water. 

Give an illustration of decomposition by (a) heat, (b) 
electricity, (c) light. 

(a) Heat mercuric oxid, and we have it decomposed into 
the gas oxygen and the metal mercury. 

(b) Pass galvanic current through water, when it will 
undergo decomposition, and hydrogen and oxygen gases will 
be set free. 

(c) Expose argentic chlorid to the action of sunlight, when 
it undergoes decomposition, producing a sub-chlorid of silver, 
and changing in color from white to black. 

What is a compound radical? Give three examples of 
compound radicals, indicating the valence of each. 

A compound radical is a chemical combination of two or 
more atoms, (and is capable of playing the part of an elemen- 
tary substance ; or a compound radical is an unsatisfied group 
of atoms. 

Examples: N0 3 , valence 1; S0 4 , valence 2; P0 4 , valence 3. 

Describe the medicinal uses of oxygen, stating how it is 
brought to the bedside and how it is applied. 

Oxygen gas subjected to pressure is liquefied and stored in 
cast steel cylinders, which though of relatively small size and 
easily transported will yield 40 gallons of the gas. These 
cylinders have adapted to them a peculiar valve that admits 
of the escape of but a minute quantity of the liquid oxygen, 
favoring its immediate change to the gaseous state. The 
gaseous oxygen is conducted into a rubber bag, and from the 
bag through a wash bottle containing a small quantity of 
water, and the patient then inhales the gas from a proper 
mouth or nose piece. In the use of oxygen we secure its flow 
by allowing the bag to fill with the gas and then compressing 



270 CHEMISTRY. 

the bag. Oxygen is indicated wherever during disease respi- 
ration is embarrassed, as during the progress of pneumonia, 
asthma, etc. 

Oxygen is frequently used for its general stimulant effect. 

State the composition, mode of preparation and proper- 
ties of sal ammoniac. 

Sal ammoniac, ammonium ehlorid, NH 4 C1, is composed of 
one equivalent of the radical NH 4 and one equivalent of 
chlorin prepared by saturating hydrochloric acid with ammo- 
nia. It is a white crystalline soluble substance. It has a 
saline taste and neutral properties. It yields ammonia gas 
when heated with strong bases. It is used in medicine as an 
alterative and as a stimulating expectorant. 

What are the distinguishing characteristics of urates 
and of uric acid, as deposited in the urine? 

Uric acid and urates, as found in urine, are of yellow to 
red color; they form the "brick-dust" sediment. 

We find them appearing as the urine cools, and they at once 
dissolve on heating the urine. Under the microscope urates 
are of yellowish color, and in form they are acicular crystals 
or spherical masses with sharp needle-like projections. 

The addition of acid, like HC1, converts the urates into uric 
acid, when the latter, being insoluble, they may be separated 
from urine. Then they are of lozenge form, rosette, and 
sometimes dumb-bell shape. 

Mention two substances that are fusible, two substances 
that are volatilized by heat, two substances that are un- 
affected by heat. 

Lead and iron are fusible. Iodin and sulfur volatilize. 
Carbon and silicon are unaffected by heat. 

Describe iron and its preparations. Why is iron pre- 
scribed in anemic conditions? 

Iron when pure is a gray- white metal, melts about 3000° 



CHEMISTRY. 271 

Fahr., specific gravity about 7, is most tenacious of metals, is 
also ductile and malleable. 

It dissolves in sulfuric acid, in dilute nitric acid and in 
hydrochloric acid. 

It oxidizes in air in the presence of moisture. 

Preparations frequently used: Ferric chlorid, ferric sul- 
fate, ferric acetate, ferrous sulfate, ferrous carbonate, the 
hydrated sesquioxid of iron, the metal itself, organic salts of 
the metal, as the peptonate, albuminate, etc. 

Iron is prescribed in anemic conditions to afford a necessary 
element for the making of red blood corpuscles. 

Give illustrations differentiating combustion, fermenta- 
tion, putrefaction and decay. 

Heat wood strongly in air and it undergoes immediate 
change into carbon dioxid gas and water vapor and a residue, 
called ash, of a mineral nature. This change, combustion, is 
accompanied by the evolution of light. Allow wood to re- 
main exposed to air and moisture for a lengthy period of time, 
when it slowly undergoes destructive 'change, yielding carbon 
dioxid gas, water vapor and a mineral ash. During this 
process of decay no light is evolved. 

Fermentation takes place only in such bodies as do not con- 
tain nitrogen. The process is initiated through the action of 
a ferment, and it yields alcohol and carbon dioxid gas. 

Putrefaction is the decomposition of substances that contain 
nitrogen, and is brought about through the presence of bac- 
teria, and constantly yields ammonia as one of its results. 

Explain the use of symbols and formulas. Give and 
translate five examples of each. 

A symbol is used as a representation of one atom of an 
elementary substance. A formula, an aggregation of sym- 
bols, represents one molecule of a substance. 

Oxygen, ; chlorin, CI ; bromin, Br ; nitrogen, N ; hydro- 
gen, H. 

HN0 3 , nitric acid; H 2 S0 4 , sulfuric acid; PbO, litharge; 
NH 3 , ammonia; NaCI, sodium chlorid. 



272 CHEMISTRY. 

What is the source of tartaric acid? What is its use in 
medicine? 

Argols, which are hard concretions found in wine casks, 
being deposited therein from fruit juices. 

Tartaric acid is used as a heat-reducing agent. It is one 
of the ingredients of seidlitz powder. Its salts are of use as 
laxatives. 

Explain the principle of the action of yeast. 

Under favoring conditions of proper 'temperature, presence 
of moisture, of air, the yeast plant causes, by its growth, 
such a rearrangement of the atoms of C, H and in glucose 
as to produce from one molecule of glucose two molecules of 
alcohol and two molecules of carbon dioxid gas. 

How is an excess of urates determined in a sample of 
urine? 

Place urine to the depth of two inches in a test-tube of 
5 x % size. Add 20 drops of strong HC1 and allow the mix- 
ture to stand 24 hours, at the end of which time the urates 
will have been converted into uric acid, and, normally, should 
yield a bulk of reddish sand-like sediment equal to half a 
wheat grain; should the deposit be greater it would indicate 
an excess of urates. 

What antidote should be employed in a case of strychnin 
poisoning? 

At once administer an emetic and tannic acid, then give 
potassic bromid in drachm doses, chloral hydrate in half 
drachm doses ; if convulsions arise use inhalation of ether or 
chloroform. Use rectal injections of chloral, etc. 

Define hydrid, specific heat, haloid salt. 

A hydrid is a binary compound containing hydrogen and 
one other element. 

By specific heat we mean the quantity of heat a given weight 
of a substance will contain compared with the quantity of heat 
a given weight of a substance taken as a standard will con- 



CHEMISTRY. 273 

tain when both standard and other substance are heated at 
the same temperature. 

A haloid salt is one that exists in sea water, or it is salt 
containing a metal in combination with a member of the 
chlorin group. 

In what respect does sterilized milk differ from raw 
milk? 

The heat of sterilizing milk coagulates the lact-albumin, 
the globulin, and modifies the casein. On acidifying the ster- 
ilized milk all the proteids are precipitated at once in a firm 
curd that will not be digested. In sterilizing milk, germs 
that may be present will be killed. 

Complete the following equations and write the name 
of each resulting compound under its formula: 

As 2 3 + 3H 2 S = 
H 2 S0 4 + NaN0 3 = 



As 2 3 + 3H 2 S ==" As 2 S 3 + 


3H 2 


Arsenic snlphid -f- 


Water. 


H 2 S0 4 + NaN0 3 = NaHS0 4 


+ HNO, 


Sodium hydrogen sulphate 


-\- Nitric acid. 



Explain the chemistry of a candle flame. 

Candle flame shows three distinct zones, inner one consist- 
ing of vaporized hydrocarbons. Gives no illumination and 
scarcely any heat. Middle flame the illuminating flame. 
Consists of solid carbon in very fine subdivision, rendered 
incandescent by the heat due to the combination of oxygen of 
the air with hydrocarbon vapors. Gives a large amount of 
heat. Third or surrounding zone darker in color, contains 
solid particles of carbon, as soot, also carbon dioxid and vapor 
of water, as a result of the burning of the hydrocarbon vapors. 
Supplies but little heat and scarcely any light. 

Write the chemical name and formula for laughing gas. 

Nitrous oxid, nitrogen monoxid, hyponitrous oxid. N 2 0. 
18 



274 CHEMISTRY. 

What is the chemical change which occurs in the making 
of malt? 

Starch is changed to maltose, C 12 H 22 11 , a variety of sugar, 
through the absorption and chemical union with water. 
Maltose consists of two starch molecules chemically combined 
with a molecule of water. 

Explain how water containing organic impurities may 
become purified by running in a shallow stream or over a 
precipice. 

This enables all parts of the water and its contained im- 
purities to be brought in contact with atmospheric oxygen, 
when the organic matter is oxidized, decomposed and forms 
harmless bodies. 

What is ammonium? 

Ammonium is a hypothetical electro-positive base, its for- 
mula NH 4 . In this form it passes in chemical change from 
union with one substance to another substance. 

It has never been isolated, but its components in the given 
proportion can be recovered from salts of ammonium. 

Mention a test of C0 2 , and also its chief properties. 

"When passed into clear lime-water it produces a white 
precipitate of calcium carbonate, or chalk, and on adding an 
excess of carbon dioxid this precipitate will dissolve, or this 
precipitate dissolves upon the addition of any acid. Carbon 
dioxid is a heavy gas about 1% times the weight of air, not a 
supporter of combustion nor of respiration. It will not burn •, 
can be liquefied and solidified. 

What elements enter into the composition of all alka- 
loids? 

Carbon, hydrogen, nitrogen, in volatile alkaloids. Carbon, 
hydrogen, nitrogen and oxygen, in fixed alkaloids. 

Explain an experiment to prove that chemical action 
may be induced by light. 

The sun's rays or diffused daylight will bring about chem- 



CHEMISTRY. 275 

ical union between hydrogen and chlorin to form hydrochloric 
acid, this union accompanied by explosive violence, so mix 
equal volumes of hydrogen and chlorin in a glass jar; place 
in the path of sun's rays. 

What is the technical name of (a) aqua regia, (b) aqua 
fortis, (c) oil of vitriol? 

(a) Nitro-hydro chloric acid; (b) nitric acid; (c) sulfuric 
acid. 

Describe the properties of hydrogen, and mention a test 
to prove that it will not support combustion. 

It is a colorless, tasteless, odorless gas, lightest of the well 
known elementary gases; burns in air or oxygen; will not 
support combustion nor animal respiration. May be lique- 
fied and (perhaps) solidified. Is strongly electro-positive, 
and is often grouped among the metals. A proof that it does 
not support combustion is afforded when on plunging a 
lighted taper into a jar of hydrogen, held mouth downward, 
the flame of the taper is extinguished, although the hydrogen 
may burn at the mouth of the jar. 

Give the composition of aqua ammonia. 

Aqua ammonia, NH 4 0H, known as ammonium hydrate or 
ammonium hydroxid, is composed of one molecule of ammonia 
gas, NH 3 , dissolved in and chemically combined with one 
molecule of water. It is thought that the radical NH 4 , formed 
through the union of NH 3 with one of the hydrogen atoms of 
water, enters into chemical union with the radical OH, left 
from the removal of one of the hydrogen atoms of water. 

What is peroxid of hydrogen? 

Peroxid of hydrogen, H 2 2 , in its purest form, is a syrupy 
liquid. 

It is usually found in commerce in watery solutions contain- 
ing 12 to 14 volumes of a gaseous peroxid of hydrogen. Such 
liquids are colorless, odorless and tasteless, have strong bleach- 
ing, disinfectant and oxidizing properties. 



276 CHEMISTRY. 

Account for the poisonous property of illuminating gas. 

Chiefly due to the presence of carbon monoxid, but also 
arising through the action of C0 2 , C 2 H 2 , CH 2 and sulfid gases. 

What is the normal reaction of (a) saliva, (b) bile? 
What causes the reaction? 

(a) Alkaline, owing to the presence of bi-carbonates and 
phosphates of the alkalies; (b) alkaline, from the presence of 
sodium salts of organic acids. 

Give formula for (a) mercuric chlorid, (b) sodic sulfate, 
(c) potassium chlorate, (d) cupric nitrate, (e) calcium car- 
bonate. 

(a) HgCl 2 ; Ob) Na 2 S0 4 ; (c) KC10 3 ; (d) Cu(N0 3 ) 2 ; (e) 
CaC0 3 . 

Define saturation. 

Saturation, when applied to a liquid, would mean that the 
liquid held dissolved all of a solid or gaseous body that it was 
capable of dissolving; we may use the term saturation with 
like meaning in speaking of the solvent powers of gases or 
vapors for other gases or vapors. 

Discuss the value of sulfur as a germicide. 

Sulfur will only act as a germicide when combined with 
oxygen to form sulfur dioxid. 

In its germicidal action, the sulfur dioxid extracts moisture 
from the germ with which it enters into chemical union to 
form sulfurous acid. It then takes to itself from the germ 
an additional atom of oxygen, to again change to sulfuric 
acid, so that we may say in its germicidal action it dehydrates 
and then deoxidizes. 

The action of sulfur dioxid, it must be remembered, is also 
that of a bleaching agent, so that care must be taken to re- 
move fabrics of any value that have color from the room, or 
the action of the gas will take away their color. 



CHEMISTRY. 277 

By what forces can (a) a solid be changed into a liquid 
or a gas, (b) a gas be changed into a liquid or a solid? 

(a) By heat or by lessened pressure; (b) by applying cold 
or by increasing pressure. 

Under exceptional conditions very great increase of motion 
may change a solid to liquid or liquid to gas, while conversely 
conditions approaching a state of rest may have a contrary 
effect. 

What is the composition of baking powders? How are 
they adulterated? What is their mode of action? 

They all contain sodium bi-carbonate mixed with an acid 
salt or a weak acid, as potassium bi-tartrate, an acid salt. 

They act through liberating C0 2 gas, as 

KHC,H 4 6 + NaHC0 8 = KNaC 4 H 4 6 + H 2 + C0 2 . 

Alum is an injurious adulterant; flour, chalk or gypsum 
may be used as adulterants to give bulk. 

What is turpentine? 

Turpentine, C 10 H ltJ , an essential oil, is a hydrocarbon ob- 
tained from the sap of pine trees.. 

State the properties and uses of H 2 S0 4 . 

It is the most corrosive of the mineral acids, exhibiting an 
intense desire to combine with moisture. 

It is a bi-basic acid, and capable of forming two classes of 
salts. It has the properties that distinguish acids in general. 
In its use we find it the most important of all known manu- 
factured substances. No civilized industry could exist with- 
out making use directly or indirectly of this acid. 

It is also of great use in the scientific pursuits. 

How does diet affect the elimination of urea? 

A nitrogenous diet tends to increase the elimination of urea. 

A restricted diet, starvation, or a non-nitrogenous diet 
diminishes the elimination of urea. 

Disease accompanied by rapid or long-continued tissue 
changes, as during high fevers, may be accompanied by in- 



278 CHEMISTRY. 

creased elimination of urea even in the absence of a nitro- 
genous diet. 

Complete the following equations and write the name 
of each resulting compound under its formula: 

C 2 H 5 C1 + AgHO = 

Sb 2 S 3 + 6HCl = 

C 2 H 5 C1 + AgHO = C 2 H 5 OH + AgCl 

Ethyl alcohol -j- Argentic chlorid 

Sb 2 S 3 + 6HC1 = 2SbCl 3 + 3H 2 S 

Antimony tri-chlorid -f- Hydrogen sulfid 

What are bromids, iodids, chlorids? 

Bromids are binary bodies composed of bromin and a basic 
element or radical. Chlorids are binary bodies, one of the 
elements of which is chlorin. Iodids are binary bodies con- 
taining iodin in chemical union with an electro-positive ele- 
ment or radical, or, as in the case of bromids or chlorids, a 
substance less electro-negative than the halogen element. 

Write the formula of (a) sulfurous acid, (b) acetic acid, 
(c) hydrochloric acid, (d) water, (e) cupric sulphate. 

(a) H 2 S0 3 ; (b) C 2 H 4 2 ; (c) HC1; (d) H 2 0; (e) CuSO<. 

What are mineral waters? 

Mineral waters are such waters as contain too great a quan- 
tity of dissolved mineral salts to warrant their use for ordi- 
nary drinking purposes ; they usually contain more than 125 
grains of dissolved mineral salts in the gallon. 

They possess various medicinal virtues in accordance with 
the particular kinds of mineral salts they contain. 

Give the composition of water by volume and by weight. 

"Water in the form of vapor is composed of two volumes of 
hydrogen and one volume of oxygen, which having entered 
into chemical union is condensed to measure but two volumes. 

Water is composed of two parts by weight of hydrogen in 
chemical union with 16 parts by weight of oxygen. 



CHEMISTRY. 279 

Give test for the presence of sulfuric acid in vinegar. 

To vinegar add a few drops of a solution of barium nitrate, 
when should sulfuric acid be present there will form a white 
precipitate that will prove insoluble in acids. 

How may the presence of arsenic in wall=paper be de- 
tected? 

Since arsenical color is usually that of an arsenite of copper, 
the presence of arsenic in the color of a wall-paper would be 
indicated if on touching the wall-paper with a drop of ammo- 
nium hydroxid an ultra-marine blue color developed at the 
wetted spot. 

This is not absolute proof of the presence of arsenic. 
Complete the following equation: 
CaC0 3 + 2HCl = 
CaC0 3 + 2HC1 = CaCl 2 + H 2 + C0 2 . 

What chemical changes take place in decaying bodies? 

A production of H 2 0, NH 3 and C0 2 , with, of course, many 
additional gaseous bodies from the presence of certain ele- 
ments. Thus if sulfur be present H 2 S or (NHJ 2 S will be 
given off ; if phosphorus be present PH 3 will form, etc. 

What is the antidote for poisoning from hydrocyanic 
acid? 

A solution of mixed ferrous and ferric sulfates with sodium 
or potassium hydroxid or carbonate added. Also use ammo- 
nia by inhalation, artificial respiration, f aradism to the heart. 

What antidotes should be used in phosphorus poison- 
ing? Why? 

Copper sulfate in solution. Acts antidotally to phosphorus 
through producing a metallic coat covering particles of phos- 
phorus. This is due to the reducing action of phosphorus 
upon metallic salts when in solution. 

Old French ozonized oil of turpentine, an antidote to phos- 
phorus, through promoting such change (oxidation) of the 
phosphorus as results in the formation of substances compar- 
atively free from poisonous action. 



280 CHEMISTRY. 

What double salts of tartaric acid are used in medicine? 

Double tartrates of potassium and sodium, called Rochelle 
salts. 

Double tartrates of potassium and antimony (SbO), form- 
ing tartar emetic. 

Double tartrate of potassium and hydrogen, or acid potas- 
sium tartrate. 

Mention five common vegetable poisons, and state the 
antidote for one of them. 

Opium, belladonna, aconite, digitalis, nux vomica. 
Antidote to opium, permanganate of potassium, atropin, 
caffein. 

Describe the preparation of hydrogen dioxid, writing 
the reaction. Give uses of hydrogen dioxid. 

Mix peroxid of barium with water, pass C0 2 gas through 
the mixture, filter, concentrate the filtrate by evaporation in 
vacuum over strong sulfuric acid. Ba0 2 + H 2 C0 3 = BaC0 3 
+ H 2 2 . Uses : For bleaching, disinfection ; it is a strong 
oxidizing agent, the restoring of oil paintings. 

Complete the following equations: 

CuS0 4 + 2KOH = 
NaHC0 3 + HCl = 

CuS0 4 + 2KOH = 'Cu(OH) 2 + K 2 S0 4 . 
NaHC0 8 + HOI = NaCl +H 2 + C0 2 . 

Describe an electric battery, and explain the operation 
of the chemicals used. 

A battery made up (for example) of six cells, each cell 
consisting of a glass jar filled with a solution of potassium 
bichromate, sulfuric acid and water, and immersed in this 
liquid a strip of zinc between two strips of carbon. 

The zinc in contact with the acid of the fluid forms sulfate 
of zinc, which dissolves in the liquid present, and hydrogen 
gas, which latter at once combines with the bichromate of 
potassium to reduce it to chromic acid. 



CHEMISTRY. 281 

The galvanic electric current passes from the metal most 
active chemically (the zinc) through the fluid to the metal or 
substance least active (the carbon). Wires attached to the 
carbon and passing from the battery cell carry the electric 
current, and these wires may be attached to the zinc of a 
second cell, and so the cells are connected in tandem. 

Finally, the wire from the carbon of the last cell leaving 
the battery will be known as the positive electrode, and should 
a continuous pathway be provided back to the zinc of the first 
cell such wire attached to the zinc would be known as the 
negative electrode. 

Give the sources and uses of ammonia in medicine and 
in the arts. 

Ammonia is now obtained from the room in which illumi- 
nating gas is washed with water, these washings containing 
ammonium hydrate. 

Ammonia, the gas, may be obtained by heating a salt of 
ammonium with a strong base. 

Ammonia is used in medicine as a cardiac and a general, 
quickly-acting stimulant. In the arts it is used as a volatile 
base, as a cleansing, detergent substance, as an ant-acid. 

Show by equation how nitric acid is formed by the action 
of sulfuric acid on potassium nitrate. How is nitric acid 
distinguished from the other mineral acids? 

KN0 3 + H 2 S0 4 = HNO3 + KHS0 4 . 

Nitric acid turns a fragment of wood to a red or orange 
color. Hydrochloric acid yields to wood a lemon-yellow color. 
Sulfuric acid turns wood dark brown or black. 

Nitric acid in contact with metal copper yields a greenish- 
blue liquid, and gives rise to orange-red fumes of N 2 4 , this 
action not being brought about by any other of the mineral 
acids. 

Indicate by chemical sign and symbols the reactions 
that occur when (a) a phosphorus match is lighted in the 
air, (b) sodium is placed on the surface of the water, (c) 



282 CHEMISTRY. 

hydrochloric acid is poured on marble, (d) two portions 
of seidlitz powder are mixed in water. 

(a)P 4 + air(50 2 ) = 2P 2 5 . 

<b) Na 2 + H 2 = Na 2 + H 2 ; then Na 2 + H 2 = 2NaH0. 

(c) 2HC1 + CaC0 3 = CaCl 2 + H 2 + C0 2 . 

(d) KNaC 4 H 4 6 + NaHC0 3 + H 2 C 4 H 4 c = 

KNaC 4 H 4 6 + NaHC 4 H 4 6 + H 2 + C0 2 . 

Describe the chemistry of alcohols and ethers. 

An alcohol is a water in which one hydrogen atom in each 
molecule of water has been replaced by an alcohol radical; 
or an alcohol is a hydrate of an alcohol radical. 

An ether is a water in which both hydrogen atoms of a mole- 
cule of water have been replaced by alcohol radicals; or an 
ether is the oxid of an alcohol radical. 

What treatment is indicated in a case of poisoning by 
mercuric chlorid? 

Administer the albumen of eggs, if possible ; if these be not 
at hand give some form of aloumen, as milk, flour, etc. 

Then use stomach pump, syphon tube or emetic, so as to 
at once remove the newly formed albuminate of mercury in 
stomach. 

Explain the constitution of the fats and the process of 
saponification. 

A fat is a chemical union of glycerin with a fat acid. 

If a base, such as caustic potash, be boiled with a fat, the 
glycerin is separated from the fat acid, the latter then com- 
bining with the base to form a salt. This salt is a soap. 

To facilitate the rise of the soap, salt is added in the process 
of soap-making. 

Complete the following equations: 
AgN0 8 + NaCl = 

Si0 2 + HF == 

AgN0 3 + NaCl = AgCl + NaN0 3 . 
Si0 2 + 4HF = SiF 4 + 2H 2 0. 



CHEMISTRY. 283 

Find the weight and the volume of hydrogen contained 
in 17 grams of NH S . 

Seventeen grams of NH 3 will yield 3 grams of hydrogen 
measuring 33.48 litres. 

What is sulfuretted hydrogen? Give its formula, prop= 
erty and uses. 

It is a colorless gas, slightly heavier than air, of offensive 
odor and poisonous action. It is soluble in water, and burns 
in air with a blue flame to form sulfur dioxid and water. It 
is used as an antagonist to chlorin. It is used as a group 
reagent, precipitating a number of metals in the form of 
insoluble sulficls. Its formula is H 2 S. 

Name and give the formulas of three important salts of 
potassium used in medicine. 

Potassium acetate, KC 2 H 3 2 . 
Potassium nitrate, KN0 3 . 
Potassium chlorate, KC10 3 . 

What is methylic alcohol? What are its properties and 
uses? 

Methylic or wood alcohol, CH 3 OH, is obtained as a product 
of the destructive distillation of wood. It is a light, colorless 
liquid, with a characteristic offensive odor. 

It is poisonous, and this, with its offensive odor, unfits it 
for use in fortifying alcoholic beverages. It has a large use 
in the arts as a solvent for resinous and gum-like substances, 
as in the making of varnishes. It is used for the obtaining 
of heat through its burning. 

Defend the statement, " Matter is indestructible." 

That matter is indestructible may be illustrated by the 
burning of a candle, where although the candle loses in weight 
from the consumption of its wax, yet if care be taken to save 
and weigh the results of the combustion of the wax and the 
products formed through the union of oxygen with the carbon 
and hydrogen composing the wax, and the weight of oxygen 



284 CHEMISTRY. 

obtained from the air be deducted, the resultant will corres- 
pond in weight with the weight the candle has lost in burning. 

Explain and illustrate the law of chemical combination 
by volume. 

Law of Gay-Lussac : When two or more gaseous constituents 
combine chemically to form a gaseous compound the volumes 
of the individual constituents bear a simple relation to the 
volume of the product. Thus one volume of hydrogen com- 
bines with one volume of chlorin to form two volumes of 
hydrochloric acid. Again, three volumes of hydrogen com- 
bine with one volume of nitrogen to form two volumes of 
ammonia. 

Give the history, occurrence in nature and preparation 
of oxygen. 

Attention was first called to the existence of oxygen by Dr. 
John Mayow, of England, in 1664. Oxygen was discovered by 
Dr. Joseph Priestley, of Birmingham, England, on August 1st, 
1774. It was given the name oxygen by Lavoisier, the 
French chemist, because he thought it rendered substances 
with which it combined acid, or was the cause of acidity of 
acids. 

It is found elementary in the air and dissolved in water. 
It is found in combination in oxids, acids, salts, hydrates, 
organic compounds. It may be prepared by heating a mixture 
of manganese dioxid and chlorate of potassium. 

Give reasons from a chemical standpoint for the use of 
gold and silver for coin. 

They do not oxidize in air or water ; when properly alloyed 
they are not much subject to abrasion ; their degree of purity 
may be readily determined by reagents; they do not commu- 
nicate an odor nor a poisonous effect when handled. 

Name three metals of the alkaline earths, giving a com= 
pound of each with its formula. 

Barium, barium chlorid, BaCl 2 . 



CHEMISTRY. 285 



Strontium, strontium nitrate, Sr(N0 3 ) 2 . 
Calcium, calcium carbonate, CaCO,. 



What are the general characteristics of the metals of 
the iron group? 

When at a red heat they decompose water ; their oxids, hy- 
drates, phosphates and carbonates are insoluble in water. 
They have relatively high fusing points, and are of consider- 
able tenacity, malleability and ductility. They are all pre- 
cipitated from their solutions, when alkaline, by hydrogen 
sulfid. 

What is coal=oiI, and what are some of its principal 
products used in the practice of medicine? 

Coal oil, or petroleum, is a brown-colored oil and is pro- 
duced from decomposition of organic matter. It is a mixture 
of various liquid paraffins, containing gases and solid mat- 
ters in solution. From coal oil we may obtain carbolic acid ; 
salicylic acid, sulphonal, phenacetin, acetanilid. 

Complete the following equation and write the name of 
the resulting compounds: 



C 2 HC1 3 + KOH = 




C 2 HC1 3 + KOH = KCH0 2 + 


CHC1 3 


Potassic formate -(- 


Chloroform. 



Give the general properties of alkaloids. 

They are of three groups, vegetable, animal and synthetic 
alkaloids. They contain nitrogen; they may be classed as 
fixed alkaloids, which, in addition to C, H and N, contain 0, 
and the volatile alkaloids which contain no 0. 

The vegetable alkaloids (fixed) are crystalline solids but 
slightly soluble in water; all are basic in reaction, and they 
form salts by direct union with acids without displacing the 
hydrogen of the acid. As a rule they are very poisonous; 
they generally represent the active principle of the drug sub- 
stance. The volatile alkaloids, like nicotin, are liquid bodies. 



286 CHEMISTRY. 

What is the percentage composition of NaN0 3 ? 

Atomic weight of Na is 23 ; of N, 14. 

Atomic weight of is 16; of 3 , 48. 

Sum of atomic weights 85 ; then 

85 :100 : :23 X = sodium, 27. per cent. 
85 .-100 : :14 :X = nitrogen, 16.4 
85 :100 : :48 :X = oxygen, 56.6 



c i. 



100.0 



Why is capillary attraction so called? Mention some 
familiar examples. 

Because this force is best observed in liquids enclosed in 
tubes the size of a hair ( capilla) . 

The passing of oil up the lamp wick. 

The flow of sap through vegetable fibre. 

The method of keeping moist the bulb of the wet-bulb ther- 
mometer. 

Define sterilization. 

Sterilization is the operation of removing that upon which 
germs depend for food for their existence. 

How does permanganate of potassium act as a disin= 
fectant? 

In contact with organic matter it undergoes decomposition, 
liberating its oxygen in a nascent form. 

Upon what theory are eggs given in cases of poisoning 
by corrosive mercury? 

That the albumen of the egg forms an insoluble albuminate 
of mercury. 

Give the boi!ing=point (Fahrenheit) of water, alcohol, 
of ether, of mercury. 

Water boils at 212° ; alcohol at 173° ; ether at 98.6° ; mer- 
cury at 680°. 



CHEMISTRY. 287 

Give the names and formulas of four iodids commonly 
used in medicine. 

Mercuric iodid, or the red iodid of mercury, Hgl 2 ; potassic 
iodid, KI; sodic iodid, Nal; strontium iodid, Srl 2 . 

Give the formula for carbolic acid. How is it obtained, 
and what are its properties and uses? 

Carbolic acid, phenol, C 6 H 5 OH, obtained from destructive 
distillation of wood or of coal, as from coal tar. AVhen pure 
is a crystalline solid with a characteristic odor, pungent and 
caustic taste, forms a white eschar on tissues. The crystals 
require an addition of but five per cent, of water to liquefy 
them ; if more water be added a turbid mixture results, which 
again becomes clear when 2000 parts of water have been added. 
Carbolic acid is soluble in 20 parts of water; glycerin favors 
its solution. It is used as an antiseptic, a disinfectant and a 
caustic. It has slight local anesthetic properties. 

Give the comparative constituent of cows' milk and 
human milk as relating to water, fat, sugar, albuminoids. 

Cows' Milk. Human Milk. 

Water 84.28 87.24 

Fats 3.66 3.78 

Sugar and salts 5.62 5.78 

Albuminoids 3.76 2.88 

It will be seen that human milk contains more fats and less 
albuminoids, but a larger percentage of sugar than cows ' milk. 

How are the compounds containing two, three, or four 
elements distinguished by name? Define hydroxid. 

Compounds composed of two elements are called binary 
compounds and their names end in "ide." 

Compounds containing three elements are ternary com- 
pounds and, if acids, their names terminate in "ic," or in 
"ous;" while if salts their names end in "ate," or "ite." 

Compounds made up of four elements are called quater- 



288 CHEMISTRY. 

nary compounds and being salts are also known as double 
salts or, in some instances, acid salts. 

A hydroxid is a chemical union of the acidulous radical 
OH with a metal or basic radical. 

Define anhydrous, deliquescent, electrolysis, decanta= 
tion. 

An anhydrous substance is one from which water has been 
removed, as anhydrous sulphate of copper. 

A deliquescent substance is one so desirous of moisture 
as to absorb it if exposed to air, as chloride of gold. 

Electrolysis is decomposition of a compound into its con- 
stituents by the action of an electric current. 

Decantation refers to the act of pouring off a supernatant 
liquid from a precipitate or sediment. 

Give the reaction of tannin with (a) preparations of iron, 
(b) gelatin. 

(a) Gives a purplish-black precipitate of a tannate of iron 
(ink). 

(b) Gives an immediately formed precipitate brown in color. 

What relation does the amount of solid matter in urine 
bear to the specific gravity of urine? 

If the specific gravity of urine be less than 1018, multiply- 
ing the last two figures of the specific gravity by 2 will give, 
in the product, the parts of solids in 1000 parts of urine. 
When urine has a specific gravity higher than 1018 we multi- 
ply last two figures by 2.33 to obtain solids in 1000 parts 
of urine. 

Give source and characteristics of citric acid. 

Citric acid, C 6 H 8 7 , H 2 0, is obtained from lemons and limes. 
Occurs as colorless, rhombic crystals, odorless, very acid, per- 
manent in dry air, but efflorescing in warm dry air and 
deliquescing in moist air. Soluble in water and alcohol, 
melting at 150° C, antiseptic, anti-scorbutic, and refrigerant: 
dose 10 to 30 grains. 



CHEMISTRY. 289 

Give the formula, synonyms and properties of (a) mer- 
curous iodid, (b) mercuric iodid. 

Mercurous iodid Hg 2 I 2 or 2HgI, proto-iodid of mercury, 
green iodid of mercury, yellow iodid of mercury is a yellow, 
tasteless powder, almost insoluble in water, easily undergoing 
decomposition into mercuric iodid and mercury, and owes its 
change in color on standing, to free mercury giving with the 
original color, a green substance. 

Mercurous iodid, in its poisonous activity, is comparable 
with calomel. 

Mercuric iodid, bin-iodid of mercury, red iodid of mercury, 
Hgl 2 , is a scarlet-red, tasteless powder, slightly soluble in 
water, becomes yellow on heating, regaining red color when 
cold or if pressed. It is highly poisonous and resembles bi- 
chloride of mercury in therapeutic activity, being, however, 
slightly less poisonous. 

Give the formula, preparation and properties of nitrate 
of silver. Mention a test for nitrate of silver. 

AgN0 3 ; formed by dissolving silver in nitric acid, evapor- 
ating the excess of acid, dissolving the residue in water from 
which silver nitrate crystallizes. It is a self-limited caustic, 
and is employed internally, in % grain doses, as an astringent 
and alterative, and is used in weak solutions as an antiseptic, 
stimulant, and slight irritant. Its use is accompanied by 
black stains. Test : A soluble chloride added to silver nitrate 
solution precipitates curdy white silver chloride soluble in 
ammonium hydrate: the silver nitrate solution evaporated 
with phenol-sulphuric acid produces the pink coloration char- 
acteristic of the nitrates. 

Mention the properties of (a) hydriodic acid, (b) hydro- 
bromic acid. 

(a) Hydriodic acid, HI, is a fuming, colorless gas, strongly 
acid, freely soluble in water to form a brown fuming liquid 
containing iodine and hydriodic acid. Hydriodic acid pos- 
19 



290 CHE3IISTBY. 

sesses, in less marked degree the general properties of hydro- 
chloric acid : it binary salts are used medicinally. 

(b) Hydrobromic acid, HBr, is a colorless gas of acid na- 
ture, soluble in water and like hydriodic acid, is disinfectant, 
bleaching and oxidizing — its binary salts are used in medicine. 

Give a test for the detection of alum in baking=powder. 

Dissolve some baking-powder in 25 c.c. water to which add 
5 c.c. of a 5% tincture of logwood, 'and 5c.c. of a 15% solution 
of ammonium carbonate when, if alum is present, a violet or 
lavender color is produced. 

Give the chemical changes occurring when potassium is 
placed on water. 

Two atoms of potassium displace two atoms of hydrogen 
from a water molecule and form K 2 when instantly this 
newly-formed potassium oxid combines with a new water 
molecule to form two molecules of potassium hydroxid, 
2KOH, this latter dissolving in the unchanged water, while 
the liberated hydrogen takes fire from the intensity of the 
chemical action and burning gives rise to a rose or violet 
colored flame the color of which is due to minute particles of 
potassium, carried up by the escaping hydrogen while heated 
to a point of incandescence. 

Define photography. 

It is the art of obtaining in permanent form the images of 
the camera obscura, by causing light to produce chemical 
changes on sensative substances. 

Write the graphic formula of (a) sulfuric acid, (b) 
nitric acid, (c) calcium hydrate. 

HO.on CI — — OH 



(a) H0 >S0 2 or S - - OH 
(b)^N-OHorfSj£o H 
(c) CaZgi 



CHEMISTRY. 291 

Describe the relations of oxygen to combustion and to 

,ife - II 

Oxygen is the great, universal supporter of combustion, 
entering into chemical union with all well known elements 
(except fluorin) often with sufficient energy to produce heat 
and light, occasioning active combustion. 

Since life is only maintained through a constant oxidation 
of existing tissues, (a form of slow combustion with slight 
evolution of heat) and the replacement of these oxidized and 
decomposed structures by new materials, oxygen is absolutely 
necessary to life. 

What mineral acids are incompatible with mercurous 
chlorid? Give synonyms of mercurous chlorid. 

Mercurous chlorid, Hg 2 Cl 2 or 2HgCl, called calomel, mild 
chlorid of mercury, proto-chlorid of mercury. 

This substance is incompatible with sulphurous acid, hydro- 
chloric acid, and, in general, with all strong mineral acids. 

Describe the appearance of urine containing bile. 

Such urine varies in color from reddish-brown to a brown- 
ish-black (porter-colored), its froth, yellow in tint, is not 
evanescent, and this urine produces yellow stains on white 
fabrics. 

Define decomposition, putrefaction. 

Decomposition refers to the breaking up of a complex or 
compound substance into simpler substances. 

Putrefaction is the decomposition of a nitrogenized organic 
substance into simpler bodies, among which ammonia, or some 
of its compounds, will be included. Putrefaction is occasioned 
through the presence of bacteria. 

Give the general definition of an ether. 

An ether is the oxide of a hydrocarbon radical. 
An ether is a water in which both hydrogen atoms of a 
water molecule have been replaced by alcohol radicals. 



292 CHEMISTRY. 

Give a test for the detection of hydrocyanic acid in 
solution. 

Silver nitrate solution, when added to hydrocyanic acid 
solution, produces a curdy white precipitate of silver cyanide, 
soluble in ammonium hydrate, and in strong boiling nitric 
acid, and not turning black on exposure to light. 

Complete the following equations: 

CH 3 Cl + HCl + Zn = 

2FeCl 3 + H 2 S = 

CH 3 C1 + HG1 + Zn = CH 4 + ZnCl 2 . 

2Fe01 8 + H 2 S == 2FeCl 2 + 2HC1 + S. 

Give the symbol, valence and a principal compound of 
each of ten elements. 

Hydrogen, symbol H, valence I, water, H 2 0. 

Oxygen, symbol 0, valence II, nitrous oxid, N 2 0. 

Nitrogen, symbol N, valence I, III, V, ammonia, NH 3 . 

Iodin, symbol I, valence I, potassium iodid, KI. 

Sulphur, symbol S, valence II, IV, VI, hydrogen sul- 
phid, H 2 S. 

Bromin, symbol Br, valence I, sodium bromid, NaBr. 

Iron, symbol Fe, valence II, IV (Fe 2 IV, VI) ferrous sul- 
phate, FeS0 4 . 

Calcium, symbol Ca, valence II, calcium hydrate, Ca2(0H). 

Magnesium, symbol Mg, valence II, magnesium carbon- 
ate, MgC0 3 . 

Silicon, symbol Si, valence IV, silicic oxid, Si0 2 . 

State the normal reaction of synovial fluid. 

Alkaline. 

Describe the microscopic appearance of (a) uric acid, 
(b) triple phosphates. 

(a) Yellow to orange-red in color, rhombic prisms or modi- 
fied forms, often grouped in star-shaped, or fan-shaped clus- 
ters, rough and sharply pointed at angles. 

(b) White, triangular prisms, coffin-shaped ; or in star- 
shaped, feathery crystals with points like fern leaves. 



CHEMISTRY. 293 

Give a typical example and state the principal ingre- 
dients of each of the following mineral waters: Saline 
cathartic, alkaline, sulphurous. 

Saline cathartic water may be represented by Carlsbad 
mineral water containing sulphates of sodium and potassium, 
and carbonates of sodium, calcium and iron. 

An alkaline mineral water as Buffalo lithia water contains 
carbonates of lithium, calcium, sodium and potassium, and 
usually an excess of C0 2 although not in sufficient amount to 
produce effervescence. 

A sulphurous water, as that of red sulphur spring of Vir- 
ginia, usually contains hydrogen sulphide, or an alkaline 
poly-sulphide. 

Give the characteristics of (a) nephritic urine, (b) cys- 
titic urine. 

(a) Nephritic urine is usually pale in color, clear, of low 
specific gravity, its froth is not evanescent, it contains a dimin- 
ished proportion of normal solids in solution, particularly 
phosphates and urea, and contains albumin, while the micro- 
scope shows the presence of casts of uriniferous tubules and 
cells and detritis from the urinary tract; its reaction is 
usually faintly acid. 

(b) Cystitic urine is alkaline in reaction, strongly ammonia- 
cal in odor, or perhaps fetid, always contains pus, may be 
stringy or gelatinous from mucus, ammonio-magnesium phos- 
phate crystals are present, blood may be present, bacteria in 
large numbers abound, cells from bladder are found, usually 
exhibits considerable sediment. 

Express the following in apothecaries' weight and 
measure: 

Ammonii carb 5 grams 

Syr. aurantii 60 c. c. 

Aquse destil. ad 120 c. c. 

Ammonii carb grs. lxxvii 

Syr. aurantii 3 ij 

Aquse destil. ad J| iv 



294 CHEMISTRY. 

Complete the following equations: 

C 2 H 5 N0 3 + KOH = 
CaC0 3 + 2HC1 = 

C 2 H 5 N0 3 + KOH = C 2 H 5 OH + KN0 3 . 

CaC0 3 + 2HC1 = CaCl 2 + H 2 + C0 2 . 

Give the general characteristics of bismuth. 

Bismuth, Bi, atomic weight 207.5, valency III and V, 
specific gravity 9.8, melts 507° F., brittle, color white with 
reddish tint, crystalline, occurs native, poor (very) in con- 
ductivity for heat and electricity, expands on solidifying from 
fusion, most strongly diamagnetic, unaffected in air when 
cold, volatilizes, and oxidizes on heating, preferable solvent, 
nitric acid. 

Define and illustrate monatomic element, neutral salt. 

A monatomic element, like mercury, is one whose molecule 
contains but one atom, and whose molecular weight would 
correspond to the atomic weight. 

If one quart of H. and one quart of CI. unite they produce 
two quarts of HC1 gas because their molecules each contain 
two atoms (they are diatomic), but if H and CI were mona- 
tomic such quantities, one quart of each, combining would 
produce but one quart of HC1 gas. 

A neutral salt is one whose watery solutions do not change 
litmus color; usually a neutral salt is a normal salt formed 
through the complete replacement of all replacable hydrogen 
atoms of an acid by metal or basic atoms or radicals. 

Indicate the sources of the following acids: Lactic, 
butyric. 

Lactic acid is developed in souring milk, and decomposing 
meat. 

Butyric acid occurs in rancid butter, and cheese. 

Mention a diatomic element and give its chemical prop= 
erties. 

Oxygen, symbol 0, atomic weight 16, electro-negative, sup- 



CHEMISTRY. 295 

porter of combustion, combines with all well-known elements 
except fluorin, diad in valency. 

Give an explanation of the formation of ammonia in the 
urine. 

Its presence is traceable to use of foods containing an excess 
of mineral, or organic, acids that are not destroyed in the 
body ; or to conditions, as in diabetes, leading to an increased 
formation of acid in the body. Ammonia, in these conditions 
is formed in the liver to neutralize and form salts with the 
excess of acid, and ammoniacal salts decompose with an 
alkaline urine. Many morbid processes, as cystitis, occasion a 
decomposition of urea into ammonium carbonate and this, in 
an alkaline urine, frees ammonia. 

Complete the following equations: 

2FeCl 2 + 2HC1 + = 
2Na 2 HP0 4 + 3CaCl 2 = 

2FeCl 2 + 2HC1 + = Fe 2 Cl 6 + H 2 0. 

2Na 2 HP0 4 + 3CaCl 2 = Ca 3 2P0 4 + 4NaCl + 2HC1. 

Give the formula and properties of (a) chlorate of potas- 
sium, (b) ammonia gas, (c) tartaric acid. 

(a) Chlorate of potassium, KC10 3 , white crystalline solid, 
soluble in 16.7 parts of cold water and 1.7 parts boiling water. 
A strong oxidizing agent, decomposable by heat into oxygen 
and chlorid of potassium, forms explosive mixtures' when in 
contact with strong acids or organic matter. It is a mild as- 
tringent and antiseptic. 

(b) Ammonia gas, NH 3 , is a strongly basic, diffusible, irre- 
spirable gas, extremely light, and very soluble in water, it is 
colorless, alkaline and caustic in taste and effect. 

(c) Tartaric acid, H 2 C 4 H 4 6 , found in vegetables and 
fruits : in its pure form occurs as colorless, transparent prisms, 
strongly acid and readily soluble in water and acids ; crystals 
melt at 135° C. It forms salts, of which Rochelle salt, 
KNaC 4 H 4 6 ; cream tartar, KHC 4 H 4 6 ; tartar emetic, 
KSbOC 4 H 4 6 are medicinally useful. 



296 CHEMISTRY. 

How is anilin obtained? State how anilin dyes are 
manufactured from anilin. 

Anilin, C 6 H 5 NH 2 is obtained through the action of hydrogen 
upon nitro-benzene. 

Anilin dyes are made by oxidizing mixtures of anilin and 
toluidin with nitric or chromic acids or other oxidizing agents. 

Mention two reactions by which hydrocyanic acid is 
formed. Give the properties of hydrocyanic acid. 

Add hydrochloric acid to potassium cyanid and obtain 
potassium chlorid and hydrocyanic acid. Add hydrochloric 
acid to silver cyanid and obtain silver chlorid and hydro- 
cyanic acid. 

Hydrocyanic acid is a volatile liquid, colorless, has odor 
of bitter almonds, very unstable, in gaseous form it burns with 
pink flame, it is extremely poisonous and is employed in medi- 
cine in a 2% water solution, the dose in this diluted form 
being but a drop or two. 

Give the symptoms and diagnostic features of oxalic 
acid poisoning. With what commonly used salt is oxalic 
acid likely to be confused? 

Symptoms: a hot, burning, sour taste, burning sensation 
extending to stomach, great burning pain in stomach and ab- 
domen causing drawing up of legs to obtain relief, entire pros- 
tration of strength, slight stupor and indifference to surround- 
ings, convulsions, pulse small and irregular, numbness of 
extremities, irregular, spasmodic breathing, death. 

Oxalic acid has been taken in mistake for Epsom salt. 

What are aldehydes? Mention the properties and prin- 
cipal derivatives of aldehydes. 

Aldehydes are alcohols which, through oxidation have lost 
two hydrogen atoms from each molecule. 

Aldehydes combine directly with ammonia, hydrocyanic 
acid, alkaline sulphites, etc. They are strong reducing agents, 
they undergo spontaneously certain modifications, their oxi- 



CHEMISTRY. 297 

dation produces fatty acids, their reduction gives rise to 
alcohols. 

As derivatives of aldehydes we have chloral hydrate, 
chloroform, etc. 

How are soaps made? What constitutes (a) hard soap, 
(b) soft soap, (c) castile soap? 

By heating a strong base, as NaOH with fat, and then add- 
ing common salt to facilitate the separation of the forming 
soap from the liquid (glycerin). 

(a) A hard soap is a sodium salt of a fat acid. 

(b) A soft soap is a potassium salt of a fat acid. 

(c) Castile soap is a mixture of oleate, palmitate and 
stearate of sodium obtained from the employment of olive 
oil in its making. 

Complete the following equation: 

K 2 Cr 2 7 + 4H 2 S0 4 = 
K 2 Cr 2 7 + 4H 2 S0 4 = Cr 2 3S0 4 + K 2 S0 4 + 4H 2 + 3 . 

What is an ion? Give an example of ionization. 

The results of the decomposition of compounds, that take 
place in dilute physical solutions of salts, or that are brought 
about through electric energy are called ions. If a minute 
quantity of sodium chlorid be dissolved in a large quantity 
of water, each drop of such solution will not contain mole- 
cules of NaCl but separate ions of sodium and ions of chlorin. 

What simple tests should be employed to determine 
whether or not a suspected water contains albuminoid 
matters sufficient to make its use unhealthful? 

Add to the water a drop or two of dilute sulphuric acid and 
enough permanganate of potassium to occasion a faint pink 
color, cover the vessel with a glass plate and if the pink color 
still persists after the lapse of fifteen minutes the water is not 
greatly impure from organic matter. 

Shake a stoppered flask when half full of the suspected 
water; then smell; if no odor is discernible, warm flask and 



298 CHEMISTRY. 

contents for fifteen minutes at a temperature not higher than 
110° F. and again shaking vigorously unstopper the flask and 
smell, when should no odor be noticed the water probably is 
free of any material quantity of dissolved organic matter. 

Mention the principal uses of the following elements 
and their compounds: (a) Fluorin, (b) chromium, (c) sili= 
con, (d) selenium. 

(a) Fluorin forms ozone when passed into water. Hydro- 
fluoric acid is used as a solvent for glass; calcium fluorid is 
employed as a flux. 

(b) Chromium no use, its oxids are fused with iron oxid 
and carbon to form a steel : some of its salts, as lead chromate 
are used as pigments, dichromate of potassium, or sodium, 
is a constituent of electropion, the oxids and acids of chromium 
are oxidizing agents. 

(c) Silicon in the form of its oxid Si0 2 is used in making 
glass ' and glass-like substances, hydro-fluo-silicic acid is a 
chemical reagent, Si0 2 is also used for polishing, filtration, etc. 

(d) Selenium is used, from its non-conducting property, in 
some electrical appliances, selenic acid, H 2 Se0 4 will dissolve 
gold. 

State the atomic weight, valence and uses of sulfur. 

Sulfur, S, atomic weight 32, valence II, IV, VI. 

Is used in making gun powder, matches, as a medicine, is 
incorporated into rubber, is burned to form S0 2 and in this 
combination used for disinfection, bleaching and in making 
sulphuric acid. 

Complete the following equations: 

BaCl 2 + Na 2 S0 4 = 

3P + 5HN0 8 + 2H 2 = 

BaCl 2 + Na 2 S0 4 = BaS0 4 + 2NaCl. 

3P + 5HN0 3 + 2H 2 = 3H 3 P0 4 + 5NO. 

State the symptoms and diagnostic features of phos= 
phorus poisoning. 

Often find symptoms resembling those of acute yellow 



CHE3IISTRY. 299 

atrophy of the liver, jaundice, suppression of urine, delirium, 
uraemia and coma. The breath often has phosphorus odor, 
may be luminous, the urine, or vomited matter, if boiled in 
acidulated solution give rise to a vapor that darkens a paper 
wet with silver nitrate solution. 

Differentiate arsenic from antimony. 

In Marsh's test on burning the evolved gas both arsenic 
and antimony would produce brown-black stain on piece of 
cold porcelain held in the flame but the stain due to arsenic 
is freely soluble in chlorinated lime solution while the 
antimonial stain is almost insoluble in this reagent. If arseni- 
cal and antimonial substances be strongly heated in air, arsenic 
forms octahedral crystals of As 2 3 which dissolving in water 
produce green and yellow precipitates respectively with am- 
monia and copper sulphate and ammonia and silver nitrate 
solutions; while antimony oxidizing gives needle-like crystals 
not giving precipitates with the ammoniated sulphate of 
copper, or nitrate of silver solutions. 

Give two chemical tests for blood. 

Add a drop of suspected liquid to a freshly-made tincture 
of guaiacum, in a test-tube, then on the surface of this liquid 
an etherial solution of hydrogen di-oxid, when, if the sus- 
pected liquid contains blood, a blue color band forms where 
the tincture of guaiacum and the etherial solution of H 2 2 
meet. 

The blood of man is injected repeatedly into the peritoneum 
of a different species of animal (as a rabbit) ; serum is then 
obtained from this animal, when, if to it human blood be 
added, a brown flocculent precipitate forms and the red blood 
corpuscles are disintegrated. 

Describe the tests for acetone, and for diacetic acid in 
the urine. 

Test for Acetone: Dissolve twenty grains of potassic iodid 
in a drachm of liquor potassae and boil; float the suspected 
urine on the surface of this solution, and at the juncture of 



300 CHEMISTRY. 

the two liquids a layer of phosphates appear, which will be 
colored yellow and studded with iodoform crystals if acetone 
was present in the urine. 

Test for Di-acetic Acid: To a freshly-passed specimen of 
urine add a few drops of a ferric chlorid solution; if a pre- 
cipitate forms, filter, and to the filtrate add a few more drops 
of the ferric chlorid solution, when, if di-acetic acid were in 
the urine, a dark red color is produced, which fades on boiling. 

Describe a test for excess of hydrochloric acid in the 
gastric contents. 

To 100 c.c. of filtered gastric contents add a few drops of 
tropaeolin indicator solution, and then titrate with T ^ alkali 
solution until the brown color of the solution fades, when, if 
more than 55 c.c. of the alkali solution were required to neu- 
tralize the acid, hydrochloric acid existed in excess in the 
gastric contents. 

Define albumose; give a test for detection. 

Albumoses are transition compounds formed in the conver- 
tion of albumin into peptone. 

Proteo-albumose and hetero-albumose are precipitated by 
nitric acid when cold; deutero-albumose is precipitated by 
nitric acid in the cold only in the presence of an excess of salt. 

Define bilirubin; describe its properties; give test for 
its presence. 

Bilirubin, C 16 H 18 N 2 3 , is a reddish-yellow pigment, derived 
from haematin, slightly soluble in water, more soluble in hot 
chloroform. 

Test : Place a few cubic centimeters of a chloroform solu- 
tion of bilirubin in a test-tube and overlay it with yellow 
nitric acid, when at the line of union of the liquids a series 
of color rings form with a green ring nearest the chloroform, 
and above this, in order, will be found rings of blue, violet, 
red, and finally, near the acid, yellow color. 



CHEMISTRY. 301 

What substances in the urine, other than glucose, may 
produce the reaction of the Fehling's test. 

Uric acid, creatinine, pyrocatechin, alkaptonic acids, allan- 
toin, glycuronic acid, lactose, pentose, albumin, chloroform, 
etc. 

Describe a chemical test that would suggest the pres= 
ence or absence of gastric carcinoma. 

A diminution or absence of free hydrochloric acid in the 
gastric contents as shown by less than 55 c.c. of a ^ alkali 
solution to occasion neutralization, on titration, of the HC1 
in 100 c.c. of gastric contents (filtered). 

Give chemical tests for the various forms of urinary 
calculi. 

A calculus which on heating to redness burns entirely away 
may be of uric acid, urate of ammonium, xanthine, cystine, 
cholesterine, fibrine, or bile pigment. 

Heat the calculus with nitric acid, then add ammonium hy- 
drate, when a purple color forming indicates uric acid or a 
urate, cystine and xanthine. Treat some of the same calculus 
with caustic potash, if no odor it is of uric acid, if an am- 
moniacal odor develops it is ammonium urate. If its solution 
in nitric acid gives yellow residue on evaporation, turning 
reddish-yellow on adding KOH and becoming violet-red on 
heating, it is xanthine. 

If the calculus leaves a residue when heated: if it gives 
the murexide test it is urate of soda (colors Bunsen flame 
yellow), potash (colors flame violet), magnesia (dissolves in 
dilute H 2 S0 4 and is precipitated by phosphate of soda and 
ammonia), calcium (after heating it gives the reactions of 
carbonate of calcium) . 

Oxalate of calcium calculus is not dissolved by acetic acid, 
but dissolves in mineral acids and gives precipitate on add- 
ing ammonia. Carbonate of calcium calculus dissolves with 
effervescence in acids, including acetic acid. 



302 CHEMISTRY. 

Ammonio-phosphate of magnesium calculus dissolves in 
acetic acid, and this solution gives crystalline precipitate on 
adding ammonia. 

Detail a test for the detection of IndoxyUpotassium sul- 
phate (Indican). 

MeMunn's method: Boil a mixture of equal parts of urine 
and hydrochloric acid with a few drops of nitric acid; cool 
and shake with chloroform — the chloroform becomes of violet 
color, and on spectroscopic examination shows an absorption 
band before D, due to indigo blue, and an absorption band 
after D, due to indigo red. 



PATHOLOGY AND BACTERIOLOGY. 



What are the characteristic features of diphtheritic exu= 
dation or infiltration of mucous membrane? 

The layers of mucous membrane undergo coagulation ne- 
crosis, and are infiltrated by a granular or fibrillar exudation 
of fibrin, and by leukocytes. 

What abnormal organic ingredients are found in the 
urine in chronic morbus Brightii? 

Tube casts — hyaline, granular or cellular; cylindroids, 
epithelial cells from urinary tubules, albumin, and at times 
leukocytes and erythrocytes. 

In what general respects do " anemia and progressive 
pernicious anemia " differ? 

Anemia refers to any blood impoverishment. Pernicious 
anemia is a very serious type of an essential anemia in which 
there is a disproportionate oligocythemia. In most anemias 
this is proportionate to the oligochromemia. 

What is cretinism, and with what is it associated? 

A disease developing in early life characterized by disten- 
sion (at times myxomatous) of subcutaneous tissues and by 
general mental and physical ill development, that is always 
associated with abnormality or absence of the thyroid gland. 

How should sputum be examined for tubercle bacilli? 

A selected portion of morning expectoration is thinly spread 
on a cover-glass, dried, fixed by heating, stained for three 
minutes in hot carbol-fuchsin, washed, decolorized and coun- 
ter-stained for one-half minute in Gabbet's solution, washed, 

(303) 



304 PATHOLOGY AND BACTERIOLOGY. 

dried, mounted in balsam, and examined under a one-twelfth 
oil immersion objective for minute red rods — the tubercle 
bacilli. 

What is infective inflammation? How does it differ 
from simple inflammation? 

Infective inflammation is that form due to the action of 
bacteria, while simple inflammation is not due to micro- 
organisms. Infective inflammation tends to spread, is more 
severe, and is often associated with marked constitutional re- 
action, the reverse being the case in simple inflammation. 

Give the morbid anatomy of acute lobar pneumonia. 

In engorgement (first stage) the affected lobe is deep red, 
boggy, slightly crepitant, and on section exudes bloody serum ; 
this passes into red hepatization (second stage), in which 
the affected lobe is dark red, solid, airless, friable, with dry, 
granular surface of section, while in gray hepatization (third 
stage) the lobe is grayish- white, solid, friable, with moister 
surface of section. Microscopically, in the first stage, there 
is intense hyperemia, with presence of serous liquid and red 
and white corpuscles in alveoli. In the second stage the air 
cells are filled by red and white corpuscles entangled in 
coagulated fibrin, while in the third stage the fibrin, erythro- 
cytes and hyperemia disappear and the alveoli are distended 
by leukocytes and granular detritus. Resolution (fourth 
stage) is characterized by liquefaction necrosis, absorption 
and expulsion of exudate. 

Give the causes and process of cerebral softening. 

The chief causes are the obstruction of cerebral arteries by 
an embolus, thrombus or arterio-sclerosis. The area thus ren- 
dered anemic degenerates and undergoes colliquation necrosis, 
and if pyogenic bacteria are present an abscess may form. 

Describe the rash and give the morbid anatomy of scar- 
latina. 

Scattered red points on a deep reddish base appear over 



PATHOLOGY AND BACTERIOLOGY. 305 

neck and chest by the second day, spread over the body, and 
after three or four days gradually fade, to be followed by 
desquamation. There are no specific lesions, but usually 
acute catarrhal or pseudo-membranous pharyngitis, acute 
diffuse nephritis, and often follicular tonsillitis, lympha- 
denitis (at times suppurative), catarrhal gastro-enteritis, in- 
terstitial hepatitis, splenic enlargement, and as complications, 
purulent otitis media, endocarditis, pericarditis, broncho- 
pneumonia. 

What is a giant cell? Give characteristics. 

A very large cell with many nuclei, found in the tubercle, 
in gumma, in. bone marrow, and in myeloid sarcoma. It is 
irregular, and often indefinitely outlined, with hyaline proto- 
plasm and from four to one or two hundred nuclei, that may 
be (as in tubercle) arranged peripherally, equatorially, at 
the poles or (as in sarcoma) near the center of the cell. 

Describe the formation of adipose tissue. 

In protoplasm of connective tissue cells, fat droplets that 
tend to coalesce and displace the nucleus are deposited. 
Finally the nucleus is displaced to extreme periphery of cell 
and may disappear, while the cell is transformed into a dis- 
tended sac filled by fat. If this take place, in many adja- 
cent connective tissue cells adipose tissue results. 

What pathological changes occur in caries? 

In caries (rarefying ostitis) there is a solution of bone with 
or without the formation of pus. A round-celled infiltration, 
often with the formation of granulation tissue, occurs in 
medulla and in Haversian canals with solution of soft and 
hard structure of bone, the ended pits being Howship's 
lacunae. 

How is dental caries produced? 

Acids (especially lactic) formed by bacteria present in the 
saliva acting upon starchy particles, progressively dissolve 
the mineral structure of the tooth, whereupon saprophytic 
20 



306 PATHOLOGY AND BACTERIOLOGY. 

micro-organisms present cause solution of the organic sub- 
stance of the tooth. 

Describe catarrhal inflammation. 

An inflammation of a mucous surface, with the fluid exuda- 
tion consisting of mucus, serum, leukocytes and desquamated 
epithelial cells in varying proportions. The area affected is 
red, swollen and bathed by exuded secretion. 

What is the line of demarcation in gangrene? 

The zone of inflammatory reaction observed in the living 
tissue adjacent to the gangrenous area. 

What is the line of separation in gangrene? 

The narrow zone of progressive ulceration and molecular 
disintegration distal to the line of demarcation that tends to 
sever the connection between the living and dead tissues. 

What post=mortem changes occur in the tissues? 

Rigor mortis, algor mortis, livores mortis, muscular relaxa- 
tion, formation of adipocere, decomposition. 

Define atrophy. Give the varieties of atrophy. 

The diminution in size and functional capacity of a part. 
It may be simple or degenerative, passive, active, senile, pres- 
sure or neuropathic atrophy. 

Differentiate fatty infiltration and fatty degeneration. 

In fatty infiltration the fat is from without affected cells, 
and appears as fat droplets that coalesce, displace and obscure 
the nucleus, and distend, but do not entirely destroy, the cells. 
In metamorphosis the cell protoplasm is converted into fat 
that appears in the form of granules or minute droplets that 
tend to cause the breaking down and destruction of proto- 
plasm and nucleus. 

Define fibromata. Give the histology of fibromata. 

A tumor of the type of fibro-connective tissue, showing 
under the microscope whorls or curving bundles of long, nar- 
row fibers having occasional narrow spindle-shaped nuclei. 
As a rule, fibromas are encapsulated and not very vascular. 



PATHOLOGY AND BACTERIOLOGY. 307 

What are the degenerative changes of arteries? 

Calcareous infiltration, hyaline, fatty and amyloid degen- 
eration. 

What pathologic changes may cicatrices undergo? 

Cicatricial contraction or distension, cicatricial keloid, 
cicatricial carcinoma, abscess and ulceration. 

What is ischemic paralysis? 

The loss of voluntary motion in a living part, the result of 
local anemia. 

Differentiate between a tubercular and typhoidal ulcer 
of the small intestine. 

The tubercular ulcer results from the action of the tubercle 
bacillus, is chronic, tends to have a long axis transverse (annu- 
lar ulcer) to bowel, to show outlying tubercles and irregularly 
thickened edges and base. The typhoid ulcer results from 
the action of the bacillus of Eberth, tends to have its long 
axis parallel to gut, to have undermined edges and thin floor, 
and often causes hemorrhage or perforation. 

Distinguish between burns inflicted on a body before 
death and those inflicted after death. 

Vesicles containing albuminous serum and an adjacent red 
zone of inflammatory reaction indicate infliction of burn dur- 
ing life, and are absent in case of burns produced after death. 

Give the causes of hemorrhage. 

Increased blood pressure, atheroma, aneurysm, fatty, calca- 
reous, inflammatory change or malignant infiltration of vessel 
wall, embolism, traumatism, hemophilia, scurvy, typhus fever, 
venoms, phosphorus poisoning, and anomalous innervation, 
as in hysteria. 

What are the causes of lymphorrhagia? 

Lymphatic obstruction or injury, as may result from 
trauma, pressure of neoplasms, aneurysms or inflammatory 
tissue, or obstruction by filaria or other parasites. 



308 PATHOLOGY AND BACTERIOLOGY. 

How does calcareous degeneration of the arteries influ- 
ence the circulation? 

Increases arterial pressure and the work of heart, causes 
imperfect blood supply, at times leading to gangrene, and 
favors thrombosis and hemorrhage (hemiplegia). 

What are pyogenic bacteria? 

Schizomycetes capable of inaugurating suppuration. 

What changes take place in simple atrophy of the liver? 

A reduction in size, with preservation of general outlines, 
and without noteworthy increase of stroma, or degenerative 
change in the liver cells. 

Describe syphilitic gummata. 

Rounded, soft or firm, grayish or yellowish, circumscribed 
masses, from five mm. to several cm. in diameter, surrounded 
by an area of fibro-connective tissue, and consisting of atyp- 
ical granulation tissue showing mucoid degeneration or central 
caseous necrosis. 

What changes characterize inflammation of bone? 

An absorption of bone, with the ingrowth of new granu- 
lation tissue (rarefying ostitis) or possibly abscess forma- 
tion, or a progressive ossification with resulting thickening 
and condensation (condensing ostitis). 

Where and what are the pathologic changes in bulbar 
paralysis? 

Degenerative atrophy and sclerosis, with shrinking of 
motor cells and degeneration of processes, affecting the glosso- 
labio-laryngeal nucleus in the medulla. 

Give the pathologic changes in sclerosis of nerves. 

An overgrowth of the supporting connective tissue and 
neuroglia, with thickening of blood-vessel walls and atrophic, 
fatty or other degenerative changes in myelin sheaths and 
axis cylinders. 



PATHOLOGY AND BACTERIOLOGY. 309 

Describe the protective agencies by which the body 
guards itself against the entrance and harmful effects of 
pathogenic bacteria. 

Phagocytosis, the ingestion and possible destruction of 
bacteria by certain leukocytes. Antitoxines, substances 
formed in the body that are antidotal to bacterial toxins. 
Bacteriolysins, substances resulting from the union of two 
bodies known as complement and addiment that produce the 
solution of bacteria. Antiseptic substances present in the 
blood serum and tissues that restrain bacterial growth. 

What is immunity? How is immunity produced? 

Immunity expresses the degree of resistance of the living 
organism against disease. It is produced by attacks of dis- 
ease, by the introduction into the body of living or dead bac- 
teria or their products, or of antitoxins or by heredity. 

Give the pathologic changes occurring in acute phlebitis. 

Congestion of vessels of vasa vasorum and effusion in the 
walls of vein of serum and leukocytes, with formation of 
thrombus within vessel. This may terminate in absorption 
and resolution, the permanent occlusion of the vein, or in 
suppuration. 

What conditions (nontraumatic) favor cerebral hemor- 
rhage? Mention the vessel from which cerebral hemor= 
rhage occurs most frequently. 

a. Arterio-sclerosis or aneurysm of cerebral vessels and 
their causes, cerebral tumor, infarction, whooping cough or 
convulsions, leukemia, pernicious anemia. 

b. The left lenticulo-striate artery. 

Give the histologic characteristics of amyloid degenera- 
tion. 

The amyloid substance appears in the form of irregular 
homogeneous, translucent, faintly granular areas of fused 
cells and intercellular substance affecting chiefly the con- 
nective tissues about the capillaries, as in the glomerulcs of 



310 PATHOLOGY AND BACTERIOLOGY. 

kidney or spleen. The adjacent epithelial cells may show 
atrophic changes or fatty degeneration. The urinary tubules 
may contain amyloid casts. 

What are the blood changes in progressive pernicious 
anemia? 

A marked and disproportionate oligocythemia, slight leu- 
copenia, poikilocytosis, and the presence of nucleated red 
corpuscles. 

Give the gross and the microscopic appearance of an 
epithelioma of the lip. 

A crusted papule or warty growth, with infiltrated base, 
that tends to undergo crater-like ulceration. Microscopically, 
an invasion of the subcutaneous and deeper tissues by irreg- 
ular columns composed of squamous epithelial cells that often 
contain pearly bodies is seen. 

Give the functions and the products of bacteria. 

Functions are reproduction, motion, absorption, excretion, 
growth; also fermentation, decomposition, disease-production. 
They may produce as products ferments, toxins, phosphores- 
cence, pigments, acids or alkalies. 

Give the causes of edema. 

Passive hyperemia, anemia, change in vessel walls or in 
vascular innervation, reduction in extra-vascular pressure, 
lymphatic obstruction. 

What are cysts? How are cysts formed? Give the 
varieties of cysts. 

Abnormal, persistent, encapsulated collections of liquid 
formed by obstruction to outlet of glands by secretion in a 
cavity without outlet, extravasation of blood or other liquid, 
softening of tissues, tumor formation, or by the presence of a 
parasite or foreign body. Varieties are simple, compound, 
and proliferous, congenital, retention, extravasation, soften- 
ing, neoplastic and parasitic cysts. 



PATHOLOGY AND BACTERIOLOGY. 311 

What varieties of degeneration may occur in lymph 
glands? 

Fatty degeneration, pigmentary infiltration, calcification, 
hyaline degeneration, amyloid degeneration. 

Mention the malignant neoplasms. 

The varieties of carcinoma, including epithelioma ; sarcoma, 
endothelioma. 

What tissues are most frequently the seat of tubercular 
formation? 

In order of frequency — lungs, lymph glands, ileum and 
larynx, joints, pleura, meninges, peritoneum, bones, spleen, 
kidneys and genito-urinary organs. 

(a) On what principle are tumors classified? (b) Men- 
tion the important classes of tumors, giving an example 
under each class. 

a. The varieties of normal tissue that they typify. 

b. 1. Adult connective tissue type, as fibroma. 

2. Embryonic connective tissue type, as sarcoma. 

3. More highly specialized tissue type, as myoma, neuroma, 
lymphangeioma. 

4. Endothelial type, as endothelioma. 

5. Epithelial type, squamous, columnar or glandular, as 
squamous papilloma, columnar epithelioma, adeno- carcinoma. 

6. Tumors of mixed type, as teratoma. 

What pathologic changes may result from cerebral 
hemorrhage? 

Cerebral hematoma, softening, cyst, cicatrix, porencephalus, 
atrophy or sclerosis. Atrophy of voluntary muscles and 
cutaneous tissues, secondary descending sclerosis of motor 
paths. 

Give the process of tubercle development. 

(1) Lodgment of tubercle bacilli, (2) Proliferation of epi- 
thelioid cells and an invasion of lymphoid cells in the affected 
area, (3) Fusion of epithelioid cells with formation of giant 



312 PATHOLOGY AND BACTERIOLOGY. 

cells, (4) Central coagulation necrosis, (5) Fusion of adja- 
cent tubercles with caseation, producing yellow tubercle. 

What is (a) productive inflammation? (b) Suppurative 
inflammation? 

(a) One characterized by the formation of new fibro-con- 
nective tissue. 

(b) One characterized by the formation of pus. 

What structures are principally involved in bubonic 
plague? How are these structures affected? 

Lymphatic glands — suppurative lymphadenitis; lungs — 
a form of bronchopneumonia; intestinal tract — hemorrhagic 
gastro-enteritis ; kidneys — an acute interstitial and parenchy- 
matous nephritis; spleen — hyperplastic splenitis. 

Mention the varieties of eczema. 

Squamous, papular, vesicular, pustular, impetiginous, ec- 
zema parasiticum, rubrum, fissum, impetiginodes, marginatum, 
papulosum, vesiculosum, pustulosum, squamosum, sclerosum, 
seborrheicum, ulcerosum. 

What pathologic conditions increase the elimination of 
urea? 

Acute fevers, inflammations, bacterial infections, in dia- 
betes, rheumatism, gout, in lithemia. 

Give the lesions of typhoid fever. 

Catarrhal entero-colitis, infiltration and hyperplasia of 
Peyer's patches, terminating in necrosis and ulceration, hem- 
orrhages, perforation or cicatrization. Mesenteric lympha- 
denitis. Splenic hyperplasia, parenchymatous hepatitis and 
nephritis. At times degeneration of cardiac or voluntary 
muscles, hypostatic congestion of lungs and ulceration of 
larynx occur. 

What pathologic changes take place in the blood plasma? 

Hypertonicity (excess of salt) ; hyperinosis (excess of 
fibrin factors) ; hypinosis — deficiency in fibrin factors; hy- 



PATHOLOGY AND BACTERIOLOGY. 313 

dremia (excess of water) ; anhydremia — deficiency in water. 
Lipemia — contains fat droplets ; melanemia — contains mel- 
anin- hemoglobinemia — contains dissolved hemoglobin. Ab- 
normalities in alkalinity. 

What conditions may cause dropsical effusion in the 
abdomen and in the lower extremities? 

Cirrhosis, or tumor of the liver, syphilitic hepatitis, valvu- 
lar heart disease, pulmonary disease, neoplasms, parasites or 
inflammatory exudates interfering with the portal circulation, 
tuberculous peritonitis. 

Give the causes and pathologic anatomy of lympha= 
denitis. 

Inflammation of lymphatic glands results from irritants, 
especially the pyogenic bacteria, the tubercle bacillus and the 
bacillus of plague. The glands are enlarged, hyperemic, soft, 
pulpy, and infiltrated by serum and red and white corpuscles, 
and may suppurate. 

What is calcific metamorphosis? 

The transformation of cells into a calcareous or mineral 
substance. 

Name some of the causes of active hyperemia and give 
illustrations. 

Paralysis of vaso-constrictor or stimulation of vaso-dilator 
nerves, mechanic, thermic or chemic irritation, as shown in 
blushing, after friction of skin, application of heat or cold, 
or action of bacterial or drug irritants. 

Illustrate and define hypostatic inflammation. 

When the circulation is insufficient the blood tends to settle 
or stagnate in dependent parts of the body (hypostatic con- 
gestion), and a form of inflammation may ensue (hypostatic 
inflammation), such as the hypostatic pneumonia occurring 
in low forms of typhoid fever. 



314 PATHOLOGY AND BACTERIOLOGY. 

What are some of the phenomena attending pus for- 
mation? 

Heat, redness, swelling, tenderness, throbbing pain, soften- 
ing of tissue, fluctuation, pointing. 

Describe the pathologic conditions in hectic fever. 

Hectic fever is a persistent form characterized by high 
exacerbations at night, and resulting from microbic action, 
and, as a rule, the formation of pus within the body. 

What are the pathologic conditions causing favus? 

The proliferation in the hair follicles of a mold, achorion 
schoenleinii. 

How are secretions affected in anemia? 

Usually decreased, although the urine may be increased 
either in bulk or relative solid contents, while the free hydro- 
chloric acid, which may be absent from the gastric secretion 
in progressive anemia, may be present in increased amount 
in chlorosis. 

What organs are most subject to tuberculosis? 

Lungs, lymph glands, serous membranes, bones, spleen, 
kidneys, adrenals, genital organs, bladder, skin. 

Name some of the changes which occur in extravasated 
blood. 

Coagulation, solution, replacement by granulation tissue, 
decomposition and suppuration, desiccation and scabbing. 

What glands are most frequently affected by amyloid 
degeneration? 

Liver, spleen, kidneys, lymph glands. 

To what diseases does calcareous degeneration of the 
arteries predispose? 

Aneurysm, hemiplegia, cerebral softening, dry gangrene. 

Give the varieties of tubercle. 

Reticulated tubercle, lymphoid tubercle, epithelioid tubercle, 



PATHOLOGY AND BACTERIOLOGY. 315 

miliary tubercle, submiliary tubercle, gray tubercle, yellow 
or crude tubercle of Laennec. 

(a) What are bacteria? (b) What conditions are favor- 
able to their increase, and (c) what is meant by their toxic 
products? 

(a) Fission fungi or schizomycetes. (b) Warmth, moist- 
ure, albuminous media, usually best if of neutral or slightly 
alkaline reaction, absence of strong actinic rays, (c) Poison- 
ous substances, toxins, ptomaines or bacterial proteids formed 
by or in bacteria. 

Name some of the principal bacteria of the staphylo* 
cocci and the streptococci groups. 

Staphylococcus aureus, staphylococcus albus, staphylococ- 
cus citreus, streptococcus pyogenes, streptococcus erysipelatis. 

Name the important pathogenic diplococci. 

Diplococcus gonorrhoeae, diplococcus pneumonias, diplo- 
coccus meningitidis capsulatus of Weichselbaum. 

What changes take place in cyanotic atrophy of the 
liver? Give the microscopic appearance of this diseased 
condition. 

A persistent passive congestion, with secondary hyper- 
plasia of the connective tissue and pigmentation of hepatic 
cells; microscope shows wide dilatation of capillaries and 
veins, with atrophy and pigmentation of hepatic cells and 
overgrowth of perilobular connective tissue. 

Define and illustrate bacilli, micrococci, spirilla. 

(a) Bacilli are rod-shaped; micrococci, spherical shaped; 
spirilla, spiral-shaped bacteria, (b) Bacillus tuberculosis, 
streptococcus pyogenes, spirillum choleras. 

Give the pathologic features of angioleucitis (lymphan- 
gitis). 

The lymph vessels are inflamed, red, swollen and dis- 
tended by a cell-laden liquid. Their walls are edematous, 



316 PATHOLOGY AND BACTERIOLOGY. 

infiltrated by leukocytes, and may be broken down if the pro- 
cess be suppurative. The cause is almost invariably micro- 
organismal, and there is usually an associated lymphadenitis. 

Mention the structural changes that occur in tubercular 
joints. 

Tubercles in the synovial membrane, subsynovial tissue or 
cancellous bone. Diffuse (tumor albus) or nodular (synovitis 
tuberosa) thickening of synovial membrane, or distension of 
joint with inflammatory serum (hydrops) or puriform liquid 
(empyema); erosion of cartilage and bone; tuberculous ab- 
scess and sinus formation. 

Give the possible causes of occlusion of the bile=duct. 

Catarrhal swelling of mucous lining, lodgment of calculus 
or parasitic worm (as ascaris lumbricoides or distoma hepa- 
tinum), invasion by coccidia, cicatricial contraction of walls 
of duct, pressure from without by an adjacent tumor or 
floating kidney, involvement in a neighboring carcinoma, sar- 
coma, endothelioma or an inflammatory process, duodenal 
disease involving the terminal papilla. 

(a) What causes contribute to obesity? (b) What tis- 
sues are most frequently invaded in obesity? 

(a) Anemia, hemorrhages, use of malt liquors, lack of exer- 
cise, hereditary tendency, over-eating, certain dyspepsias. 

(b) The subcutaneous tissues and subserous tissues of abdo- 
men, especially about kidneys, in great omentum and appen- 
dices epiploicas. 

In what order are the organs of the thorax and abdomen 
best examined at a post=mortem section? 

Authorities differ. The following is useful: Inspection of 
abdominal cavity, inspection of pleura, pericardium, heart and 
vessels, examination of heart, lungs, organs of neck, spleen, 
gastro-intestinal tract, liver, pancreas, genito-urinary organs, 
abdominal aorta and sympathetic ganglia. 



PATHOLOGY AND BACTERIOLOGY. 317 

What is the special cause of the croupous inflammation 
found in diphtheria? 

The toxin of the diphtheria bacillus. 

Describe the comma bacillus and give the manner of its 
introduction into the system. 

A spirillum, a short, curved rod .8 to 2 microns in length, 
motile, flagellate, readily staining but decolorized by Gram's 
method, usually enters through the alimentary canal with 
contaminated water, milk or solid food. 

What conditions give to the system immunity from the 
harmful action of bacteria? 

The bacteriolysins, the antitoxins, the phagocytes, the anti- 
septic action of tissue cells and juices, the protecting layers 
of epithelium. 

(a) Give the microscopic appearance of a me!ano=sar- 
coma and (b) state its usual sites of development. 

(a) Consists usually of vascularized tissue consisting of 
spindle cells, or at times of round cells, that have vesicular 
nuclei, and many of which contain dark pigment granules, 
(b) Skin and choroid. 

Describe the pathologic conditions in meningitis. 

An inflammation of the membranes of brain or cord char- 
acterized by congestion of meningeal vessels, edema of arach- 
noid, effusion of serum, fibrin, or pus into the cavity of arach- 
noid, at times petechial or larger hemorrhages within or with- 
out arachnoid. Adjacent degeneration of nervous substance 
may occur. 

Give the pathology of cirrhosis of the liver. 

A marked hyperplasia of the interlobular connective tissue, 
and often of interlobular bile ducts. The new-formed con- 
nective tissue tends to contract, compressing the lobules and 
perhaps causing degeneration of the hepatic cells. The liver 
may become much smaller and show a rough ("hob nail") 
surface. 



318 PATHOLOGY AND BACTERIOLOGY. 

(a) How is fibrous tissue formed? (b) What tumors 
are composed largely of fibrous tissue, and in what part of 
the body do they usually occur? 

(a) By a proliferation of cells of the pre-existing, adjacent 
fibrous tissue. The young cells or fibroblasts being nourished 
by new capillary blood-vessels that sprout from neighboring 
pre-existing vessels and invade the formative area. 

(b) Fibromas and fibromyomas chiefly occur in the uterus. 

What is the significance of tube=casts in the urine? 

Tube-casts result from irritative and degenerative changes 
in the epithelium of kidney, permitting an exudation of coag- 
ulable substance into the tubules, and signify renal irritation 
or disease. They are minute cylindric bodies having a homo- 
genic matrix, in which there may be imbedded cellular or 
granular particles. 

Describe yellow or crude tubercle. 

A yellowish, rounded, firm, adherent body, one to several 
millimeters in diameter, showing under microscope a central 
caseous area, an intermediate zone of epithelioid cells and 
often giant cells, and a peripheral zone of lymphocytes. 

Give the structural differences between sarcoma and 
carcinoma. 

Sarcoma consists of connective tissue of embryonic type 
containing imperfectly formed blood-vessels. Tissue may 
consist of round, oval, spindle or, in part, of giant cells. 

Carcinoma is less circumscribed, consists of alveoli filled by 
cuboidal, columnar or squamous epithelial cells in a stroma, 
usually of fibro-connective tissue, that contains well-informed 
blood-vessels and lymphatics. 

Define anemia, hyperemia, leukemia. 

Anemia is deficiency in the quantity or quality of circulat- 
ing blood. 

Hyperemia is an excessive quantity of circulating blood in 
a part. 






PATHOLOGY AND BACTERIOLOGY. 319 

Leukemia is a grave primary anemia characterized by enor- 
mous leucocytosis and pathologic changes in the spleen, red 
marrow or lymphatics. 

State the difference between degeneration and infiltra- 
tion. Illustrate. 

Cell degeneration is a condition in which the cell contents 
become abnormal. If abnormal from the deposit of substance 
from without it is termed cell infiltration, as in fatty infiltra- 
tion. If abnormal from transformation of cell contents it is 
termed a cell metamorphosis, as in fatty metamorphosis. 
Fatty infiltration and fatty metamorphosis are both examples 
of cell degeneration. 

Give the morbid anatomy of chronic bronchitis. 

Mucous membrane may be red and thickened and covered 
by thick mucus; or pale, thinned, and showing adherent, in- 
spissated mucous masses. The thickening is due to leuco- 
cytic infiltration and overgrowth of fibrous tissue; the thin- 
ning to atrophy of the mucous membrane. The ciliated cells 
may be replaced by columnar or polygonal epithelium. 

What is thrombosis? Describe the manner of its for- 
mation. 

Thrombosis is the intravascular coagulation of blood during 
life resulting from the arrest of circulation and the formation 
of fibrin by the action of fibrin ferment upon the fibrinogen. 

a. What is mucoid degeneration? b. What is colloid 
degeneration? 

a. A conversion of cells and intercellular substance into 
mucin. 

b. A conversion of cells into colloid material, a substance 
resembling mucin but not giving its reaction. 

State the results of stenosis of the tricuspid valves of 
the heart. 

Dilatation of right auricle, cyanosis of face, passive hy-^^ 
peremia of pulmonary and abdominal organs, anasarca. ^^& 




320 PATHOLOGY AND BACTERIOLOGY. 

a. Define fatty metamorphosis, b. Give its termina= 
tions. 

a. Conversion of cells into fat. 

b. Destruction of cells, colliquation or caseous necrosis. 

What are the possible lesions in the third stage of 
syphilis? 

Gummata, syphilitic rupia, sclerotic changes in organs, 
especially the arteries, liver, kidneys and spinal cord. 

Describe the local appearances in a case of embolism of 
the middle meningeal artery. 

The affected vessel contains thrombus extending from the 
seat of embolism back as far as the first collateral branch. 
The distal branches may be shrunken, anemic, and associated 
with cerebral softening or distended, and in the midst of a 
hemorrhagic effusion (hemorrhagic infarction). 

What is productive inflammation? 

Inflammation characterized by the formation of new tissue, 
usually of the nbro-connective tissue type. 

What changes take place in hypertrophy of the heart? 

An increase in thickness of the muscular walls of the heart, 
chiefly affecting the ventricle, blunting the apex. The cavi- 
ties may or may not be increased in size. 

Give the origin and appearance of papillomata. 

Originate from overgrowth of the papillary body, and are 
wart-like, villous, dendritic or polypoid outgrowths from skin 
or mucous membrane covered by epithelium. 

Briefly describe the types of gangrene, and give the 
conditions determining each. 

Dry gangrene or putrefactive death of a part with mummi- 
fication is characterized by a dry, shriveled, blackish, leathery, 
friable area, and is caused by arterial obstruction, such as 
ccurs in old age (senile gangrene), from arterio-sclerosis, in 
aynaud's disease, from ergot poisoning and frost bite. 



PATHOLOGY AND BACTERIOLOGY. 321 

Moist gangrene is characterized by swollen, greenish or 
blackish, cool, moist, soft, fetid area, with bleb-covered sur- 
face, loosened epidermis and crepitation on palpation, and is 
due to severe infection (pulmonary gangrene, malignant pha- 
gedena, hospital gangrene) , trauma, venous obstruction, dia- 
betes (diabetic gangrene), and deficient trophic innervation 
(decubitus). 

Describe the histological elements of carcinoma. 

Acini containing epithelial cells. The amount of protoplasm, 
as in other epithelial cells, is large in proportion to the size of 
the nucleus. Cells may be squamous, cylindric, cuboidal or 
polyhedral. The nuclei are usually vesicular and atypical 
karyokinetic, and other cell figures may be present. The 
stroma usually consists of well-informed fibro-connective tissue 
containing lymphatics and well-formed blood-vessels. 

Describe tuberculosis of the skin in any of its forms. 

Lupus vulgaris is characterized by brown nodules originat- 
ing in corium, and consisting of a rather vascular granula- 
tion tissue composed of epithelioid cells, lymphoid cells, and 
frequently of giant ceils. The nodules may lead to extensive 
ulceration and cicatrization. 

Describe the changes in the heart due to fatty rneta- 
morphosis. 

Diffuse or circumscribed, yellowish, opaque, soft, friable 
areas of heart muscle, in the circumscribed form chiefly occur- 
ring under endocardium of papillary muscles. Microscopic- 
ally, the muscle fibres lose their striation and show fatty 
granules, usually first about the nuclei; finally fibres may 
break down into fatty particles and detritus. 

What histological changes occur in acute simple inflam- 
mation? 

Dilatation of blood-vessels, retardation and stasis of blood 
current, exudation into tissues of modified plasma, transmi- 
gration of leukocytes, and often diapedesis of erythrocytes, 
21 



322 PATHOLOGY AND BACTERIOLOGY. 

distension of lymphatics by exudate of cells and fluid, regen- 
erative or degenerative changes in the tissue cells. 

Give the pathology of carcinoma. 

Carcinoma is a malignant, uncircumscribed tumor consist- 
ing of acini, containing invaded epithelial cells in a vascular- 
ized stroma that usually consists of fibro-connective tissue. 
The epithelial cells tend to a progressive invasion through 
the lymphatic channels. 

What is fibrinous degeneration? 

A retrogressive process in which, by the action of fibrin 
ferment upon fibrinogen, fibrin is formed. 

What do you understand by the term cirrhosis of the 
liver? 

Overgrowth in the liver of connective tissue that contracts, 
rendering the organ smaller and firmer. 

Is cerebro=spinaI fever more generally sporadic or 
endemic? 

Cerebro-spinal fever generally occurs in the form of small 
sporadic epidemics. 

Give some of the lesions in chronic diffused or inter- 
stitial nephritis. 

Macroscopic. Small, granular-surfaced kidney with adhe- 
rent capsule and thinned cortex. 

Microscopic. Thickening of Bowman's capsules, hyaline 
degeneration of glomerules, increase of intertubular tissue, 
dilatation of certain tubules. 

What anatomic changes take place in the skin in chronic 
eczema? 

Enlargement of papillae, dilatation of blood and lymph 
vessels, perivascular cellular infiltration, hyperplasia of con- 
nective tissue and epithelium, atrophy of sebaceous and sweat 
glands. 



PATHOLOGY AND BACTERIOLOGY. 323 

Give the varieties, the histology, and the physical char- 
acteristics of lipomata. 

a. Diffuse and circumscribed, sessile or pediculated. 

b. Resembles normal adipose tissue, consisting of fat-dis- 
tended cells supported in a light fibro-connective tissue frame- 
work. 

c. Greasy, lobulated, yellowish, encapsulated, soft growths. 
The overlying skin "dimples" when elevated. 

What part of the cord is involved in locomotor ataxia? 
Give the pathology of locomotor ataxia. 

a. Posterior columns. 

b. In columns of Goll and Burdach areas of degeneration 
showing destroyed myelin sheaths and axis cylinders and a 
proliferation of neuroglia occur. 

What are the intestinal changes in chronic enteritis? 

The mucous membrane and muscular wall may show hyper- 
plastic thickenings or atrophy. Enlargement of lymph fol- 
licles is frequent, and polypoid masses may project from 
mucous membrane. Ulcers may be present. 

Define myomata, neuromata, angiomata. 

a. Myomata are tumors of the type of muscle. 

b. Neuromata are tumors of the type of nerve tissue. 

c. Angiomata are tumors of blood or lymph vessels. 

Explain the development of pus corpuscles. 

Migrating leukocytes pass through the walls of the adja- 
cent capillaries, and in large numbers invade the area of sup- 
puration, and whether living or dead as soon as they are sur- 
rounded by liquor puris are termed pus corpuscles. 

Give the pathology of spina bifida. 

The spinal lamina being congenitally imperfect, the con- 
tents of the spinal canal tend to protrude in the form of a 
tumor. The mass usually contains fluid, and is covered by 
the attenuated cord, nerves, or by the membranes alone. 



324 PATHOLOGY AND BACTERIOLOGY. 

Spina bifida occulta is a form in which the vertebral cleft is 
unassociated with the formation of a tumor. 

What are the pathologic conditions in gonorrheal op= 
thalmia? 

A purulent conjunctivitis with marked chemosis, edema of 
eyelids, profuse purulent discharge, and as complications, 
ulcerative or suppurative keratitis, with or without resulting 
perforation, anterior synechia, leucoma, staphyloma, iritis, 

hypopyon. 

What are the pathologic appearances of anemia of the 
brain? 

The blood-vessels are empty or imperfectly distended by 
blood, and if the process has been long continued the brain 
may show atrophy or degenerative changes in the involved 
areas. 

What is embolism? 

Intravascular obstruction from the lodgment of a foreign 
body. 

What is an infarct? 

The area of degenerative and inflammatory changes pro- 
duced by the lodgment of an embolus in an end artery. 

Describe the pathologic conditions present in atheroma. 

A diffuse or circumscribed mesarteritis occurs with involve- 
ment of vasa-vasorum and the production of new sclerotic 
tissue that undergoes coagulation necrosis and fatty degener- 
ation. This softened degenerative material is termed athero- 
matous. It may become calcified, be discharged with the 
formation of an atheromatous ulcer or cause a weakening of 
the wall, favoring rupture or aneurysm formation. 

What structural changes take place in chronic gout? 

Polyarthritis, with deposits of urate of sodium in articular 
cartilages, and about joints with formation of concretions 
(tophi). Arterio-sclerosis, hypertrophy of left ventricle and 



PATHOLOGY AND BACTERIOLOGY. 325 

sclerotic changes in liver and kidneys are common, and there 
is a tendency to inflammation of the larger serous sacs. 

What are the four cardinal indications of inflammation? 

Heat, swelling, redness and pain, to which may be added 
altered function. 

Define ascites. 

An abnormal collection of serous fluid in the peritoneal 
cavity. 

What condition of the blood is generally prominent in 
all forms of gout? 

Excess of sodium urate. 

Give some of the causes (pathologic) of paresis. 

A chronic, progressive meningoencephalitis characterized 
by a productive arteritis involving especially the adventitia, 
with degenerative atrophy and sclerosis of cortex and sub- 
cortical portions of brain. Degenerative changes in spinal 
cord are associated. 

What is the pathology of aneurysm? 

A localized enlargement of an artery containing blood or 
clot, due to a circumscribed stretching of one or all the coats of 
a vessel. It occurs in vessels weakened by trauma, arterio- 
sclerosis, mycotic inflammation, or by ulceration, or proximal 
to areas of thrombosis or embolism. The vessel walls forming 
the aneurysm are thinned, often calcified, with impaired elas- 
ticity, and usually having thicker or thinner lining of adhe- 
rent, laminated fibrin. 

Describe the pathological conditions in icterus. 

The skin, conjunctivae, urine, blood and the various organs 
are tinged a yellow color by the biliary pigment. The feces 
are usually clay-colored. The pulse is slow; there is a ten- 
dency to hemorrhage. 

Define the term malignant as applied to new formations. 

New growths having an inherent tendency to a fatal issue. 



326 PATHOLOGY AND BACTERIOLOGY. 

Give the pathology of peritonitis. 

The peritoneum is red from vascular injection, the surface 
is dull, and may be covered by adherent fibrinous or purif orm 
exudate. The cavity of the peritoneum contains serum, in 
which there may be fibrin or pus. There is a tendency for 
adjacent peritoneal surfaces to adhere, localizing the process. 

What is understood by the phrase " new formation?" 

A multiplication of certain cells of the body producing a 
mass of tissue that has no place in the normal organism, such, 
for example, as a tumor. 

By examining the fluid removed by lumbar puncture, 
how may we distinguish between tubercular and other 
forms of meningitis? 

In tuberculous meningitis the fluid contains chiefly lympho- 
cytes, and by staining, or inoculation into animals, the pres- 
ence of the tubercle bacillus may be demonstrated. In other 
forms of meningitis the cerebro-spinal fluid, as a rule, is more 
turbid, contains chiefly polymorpho-nuclear leukocytes, and 
the causal organisms, as the pneumococcus, the diplococcus 
intracellularis meningitidis or other bacterium, but not the 
tubercle bacillus. 

Differentiate a tuberculous joint from one enlarged by 
chronic rheumatism. 

Tuberculous joint-disease occurs chiefly in children, affects 
usually but a single joint, has insidious onset, with slight and 
often characteristically reflected pain, and muscular rigidity; 
is persistent, and tends to cause flexion and pale, doughy 
thickening of joint, with later the formation of cold abscess 
and sinuses. Rheumatism usually involves several joints, 
has acute onset, is transient, with marked localized tender- 
ness, and if severe, redness and swelling. 

What part of the spinal cord is involved in progressive 
muscular atrophy? 

The anterior horns of the gray matter. 



PATHOLOGY AND BACTERIOLOGY. 327 

a. What features render a tumor malignant? b. Men- 
tion some of the growths considered malignant. 

a. Invasion of adjacent tissue, recidivity, metastasis, the 
production of cachexia. 

b. Carcinoma, sarcoma, endothelioma. 

What is lardaceous (amyloid, waxy, bacony) degener- 
ation? 

The transformation of tissue into a homogeneous, wax-like 
albuminous material, giving a mahogany-brown color with 
dilute Lugol's solution. 

What is the pathology of plastic inflammation? 

A modified serum, leukocytes and at times erythrocytes 
escape from the vessels. The fibrin factors in this exudate 
unite, producing fibrin that may cause adhesion between con- 
tiguous viscera. Later this plastic exudate may break down, 
or, if it be replaced by new fibro-connective tissue, more or less 
permanent adhesions may result. 

What are some of the results of lymphorrhagia? 

Chylous extravasation, lymph fistulae, chyluria, chylothorax, 
chylous ascites, malnutrition, death. 

What conditions may result from enlargement of lymph 
spaces or lymph vessels? 

Capillary, cavernous or cystic lymphangioma, cystic hy- 
groma ("hydrocele of the neck")? macroglossia (of tongue), 
macrocheilia (of lip), elephantiasis, lymph scrotum. 

What inflammatory conditions may result in enlarge- 
ment of the lymphatic glands? 

Infection by pyogenic bacteria, plague, syphilis, tubercu- 
losis. 

What non-inflammatory condition may produce enlarge- 
ment of lymph gland? 

Hodgkin's disease (pseudoleukemia), leukemia (especially 
lymphatic types), lymphadenoma, secondary tumors (carci- 
noma, sarcoma) in lymph glands. 



328 PATHOLOGY AND BACTERIOLOGY. 

Give the pathologic features of mechanical hyperemia 
of the liver (nutmeg liver). 

A chronic, passive hyperemic condition resulting from val- 
vular heart disease, emphysema, pleuritic exudations, aneu- 
rysm, or other obstructions to venous return. The liver is 
more or less enlarged and is deeply mottled, this being due to 
the distension of the capillaries near the center of the lobules 
by blood, often with atrophy of the adjacent hepatic cells, 
while the liver cells at the periphery of the lobules may show 
fatty or other degenerative changes. 

Describe the formation of an acute abscess. 

By stages : 1. Local tissue irritation, usually from the pres- 
ence of pyogenic bacteria. 2. Exudation of modified serum 
and many leucocytes. 3. Colliquation necrosis in affected 
area, resulting in the formation of cavity (abscess) filled with 
a liquid (pus), consisting of fluid part (liquor puris) and 
many dead and living leucocytes (pus cells) . 

Describe symbiosis with special reference to patho= 
genesis and cite an example. 

Symbiosis refers to the modifications in the activities of 
different species of bacteria resulting from their association 
as compared with their activities when in pure culture. Thus, 
the injurious affects of the tubercle bacilli upon the tissues 
are greatly increased when the bacilli are in association with 
streptococci or staphylococci. Upon the other hand, anthrax 
bacilli become less virulent when mixed with cultures of 
Bacillus prodigiosus. 

Give a general description of the action of agglutinins. 

Agglutinins are substances observed chiefly in the blood 
serum of infected animals, which when brought in contact with 
living or dead bacteria of the same species as those having pro- 
duced the infection, cause the bacteria to become immotile, and 
to agglutinate or collect in clumps. The action is usually 
specific; that is, it occurs only against bacteria of the same 
species as that causing the infection. It is not necessarily 



PATHOLOGY AND BACTERIOLOGY. 329 

associated with the death of the bacteria, and as agglutinins 
may be produced by the action of bacteria upon culture 
media, the animal body is not essential to their formation. 

Describe the process of ulceration. 

Ulceration or the production of an ulcer is an inflammatory 
process in which a definite loss of substance from a surface 
of the body is produced. The area may be destroyed by the 
injurious action of physical or animate agents, by interfer- 
ences with the circulation, or as a result of the progress of 
tumors. The tissue of the involved area is first removed by 
processes of necrosis, or mechanically. The area left has 
borders of more or less healthy tissue which become the 
seat of extension or of healing of the ulcer; and a floor or 
base, which usually becomes occupied by granulations, or, 
if the ulcer be progressive, by necrotic and sloughing tissues. 
Ulceration may be a chronic, indolent process, may be progres- 
sive, leading to extension of the ulcer, or as usually occurs, 
it becomes arrested and cicatrization, or healing of the area, 
occurs. 

Describe the changes that occur in cartilage in arthritis 
deformans. 

The cartilage becomes softened, fissured, and develops sur- 
face excavations which may extend deeply into the bone. 
Simultaneously, other cartilage cells may proliferate and pro- 
duce nodular, cartilaginous projections. Medullary spaces 
invade the degenerating and proliferating cartilage, and it is 
transformed in part into osteoid tissue. Villous or nodular, 
fatty, calcareous or bony outgrowths may spring from the 
synovial membrane, and if they become detached, form free 
joint bodies. The bones making up the joint become more 
flattened, more porous, excavated, or the seat of new bony pro- 
cesses; and fibrous ankylosis, subluxation or luxation fre- 
quently follow. 

Enumerate the most ordinary senile changes that occur 
in the various tissues of the body. 

In organs, atrophy and increase of fibro-connective tissue 



330 PATHOLOGY AND BACTERIOLOGY. 

elements. In bones, absorption of osseous tissue, and cer- 
tain changes in form, especially noted in the edentulous man- 
dible, and in the neck of the femur. In walls of arteries and 
veins, arteriosclerotic changes, with tendency to calcification. 
In joints, degenerative changes, resembling rheumatoid arthri- 
tis of a mild type. In skin and adipose tissue, wasting and 
atrophy. 

Describe how mitral stenosis and aortic regurgitation 
respectively affect the cavities and musculature of the 
heart. 

In mitral stenosis, as the left ventricle receives insufficient 
blood, it may atrophy. As the left auricle insufficiently 
empties, it hypertrophies and dilates. Secondarily, the back 
pressure through the lungs increases the work of the right 
ventricle, which hypertrophies. The cavities of the right 
ventricle and left auricle are increased and their walls are 
thickened. The cavity of the left ventricle decreases in size, 
and has unaltered or thinned walls. In aortic regurgitation, 
much of the blood which has left the left ventricle is per- 
mitted to return, so that the ventricle receives not only the 
normal blood from the left auricle, but also the return leak 
from the aorta. This results in distension of the cavity and 
compensatory hypertrophy. This may cause an enormous in- 
crease in the thickness and size of the ventricle. Eventually 
the ventricle becomes incompetent, or in its distension pro- 
duces mitral insufficiency, and there ensues an auricular 
hypertrophy, and dilatation, pulmonary congestion, and finally 
distension and hypertrophy of the right heart. An enormous 
heart ( cor-bovinum) may thus be produced. 

Describe the bacillus tuberculosis, its habitat, mode of 
growth and method of detection. 

The tubercle bacillus has the form of a minute, slightly 
curved rod, with rounded ends, and an average measurement 
of 2 x .35 microns. It occurs singly and in small groups. Its 
hibitat is the tissues of vertebrates. Precise knowledge of its 
natural growth outside of the body is wanting. Its growth 



PATHOLOGY AND BACTERIOLOGY. 331 

under artificial cultivation is slow, requiring several weeks 
for colonies to develop, and necessitates special media, such 
as glycerine agar, or special blood serum. Pale gray or yel- 
lowish, dry, wrinkled, rather firm, crustlike, surface masses 
are formed by the growth of the bacteria. Growth usually 
occurs only at a temperature about that of the body, in 
the absence of strong light, and in the presence of free 
oxygen. 

It is detected — (a) by inoculating guinea-pigs with some 
of the suspected material, and six weeks later killing them 
and searching for the characteristic lesions of tuberculosis. 
Or — (b) by staining spread smears of suspected material three 
minutes with hot carbol-fuchsin and decolorizing for five min- 
utes with a three per cent, solution of HCL in absolute al- 
cohol. Tubercle bacilli retain the red fuchsin color after this 
treatment, while nearly all other bacteria are decolorized. 

Describe the microscopic appearances of acute paren= 
chymatous nephritis and explain the origin of blood in the 
hemorrhagic form. 

The microscopic changes may be chiefly of the glomerules 
— glomerulo-nephritis, or in convoluted tubules — tubulo-ne- 
phritis, or may affect all the parenchyma. In the capsular 
spaces are glomerular or desquamated epithelial cells, leuko- 
cytes, erythrocytes and plastic or granular exudate. The 
epithelial cells may show cloudy swelling, fatty metamor- 
phosis, or karyokinetic changes indicating regenerative ef- 
forts. Where the walls of the vascular tuft in the glomerulus 
give way, a hemorrhage occurs, distends the capsules, flows 
down the renal tubules, coagulates there, and forms blood 
casts. The cells lining the tubules (especially the convoluted) 
show cloudy swelling, fatty metamorphosis, or even necrosis, 
and hyaline, granular, cellular, or hemorrhagic casts fill the 
tubules. 

Describe the pathologic histology of amyloid liver and 
state where the deposit occurs. 

The amyloid substance is formed in the connective tissue 



332 PATHOLOGY AND BACTERIOLOGY. 

framework of the liver, appears in or about the walls of the 
capillaries, as anuclear, homogeneous cylinders, and as irregu- 
lar wax-like masses in the tissues which displace the cells of 
the parenchyma, and perhaps favor the atrophic, fatty, de- 
generative changes that they show. The amyloid substance 
does not take the usual nuclear stain, but is given a reddish 
color by gentian violet. 

Describe the lesions characteristic of chronic alcoholism. 

The lesions produced by chronic alcoholism also occur from 
other toxic causes, and it is difficult to state that any are 
absolutely characteristic of alcoholism alone. In the nervous 
system a form of multiple, peripheral neuritis (alcoholic 
neuritis) characterized by swelling, redness, infiltration, and 
degeneration that may be perineural or interstitial, occurs. 
The myelin may be degenerated, and the axis cylinders show 
varicosities or granular degeneration, and finally may be 
destroyed and replaced by connective tissue that is sometimes 
infiltrated with fat. In the central nervous system opaque 
thickening of the meninges with wasting of the cerebral 
convolutions, are common. Hemorrhagic pachymeningitis 
may also result. The liver may be reduced in size with irre- 
gular surface, increase of connective tissue framework, and 
degeneration of parenchyma (gin-drinkers' liver). The typi- 
cal beer drinkers' liver is a much enlarged organ showing 
fatty degeneration. The stomach and intestines may be di- 
lated, the atrophied mucosa being the seat of a chronic 
catarrh with fibrous interstitial changes. The arteries 
usually show arterio-sclerotic changes, frequently associated 
with cardiac dilatation. The superficial capillaries and 
venules, especially of the cheeks and nose, are dilated and 
have thickened walls (acne rosacea). The kidneys are less 
affected than the organs of the digestive tract, but are often 
enlarged or contracted and show arterio-sclerotic changes. 
The resistance to tuberculosis and other infections is de- 
creased in topers. 



PATHOLOGY AND BACTERIOLOGY. 333 

Describe why and how obstructive disease of the coron= 
ary arteries causes myocardial degeneration. 

The coronary arteries are end arteries with only capillary 
anastomoses between their terminal branches, and supply the 
myocardium with nutriment. Therefore unless abnormal 
anastomoses exist or a vicarious compensating flow through the 
vessels of Thebesius and the coronary veins occurs, obstruc- 
tion to the circulation in the coronary arteries results in 
ischemia and degeneration or death of the heart muscle sup- 
plied by the obstructed vessel. A coronary thrombus or em- 
bolus causes a myocardial infarct. A more gradual obstruc- 
tion may lead to a fibrous myocarditis. 

Explain the pathological characteristics respectively of 
exudative and productive renal degeneration. 

In the exudative renal degeneration there is an escape of 
blood serum, leukocytes, at times erythrocytes, and the pro- 
ducts of epithelial cells into the capsules of Bowman, the 
renal tubules, and at times into the intertubular connective 
tissue. In the productive renal degeneration there is a new 
growth of fibro-connective tissue about the capsules of Bow- 
man, about the blood vessels, and in the capsule proper of 
the kidney. Often there is an association of productive and 
exudative changes in the same organ. 



SURGERY. 



Describe a cartilaginous tumor. Where are such 
growths most commonly found? 

A cartilaginous tumor (chrondroma) is a tumor composed 
of hyaline cartilage. They are most commonly found in con- 
nection with some of the long bones, particularly the meta- 
carpal bones and phalanges of the hand, the humerus, the 
tibia, the femur, and rarely the ribs. They may also occur 
in the parotid gland, testicles, breast, or thyroid gland, but 
in these situations they are usually associated with some other 
variety of tumor. 

Mention the inflammatory diseases of bone. 

Periostitis, ostitis, and osteomyelitis. 

What is inflammation? How does inflammation extend 
and how may it terminate? 

"Inflammation is the succession of changes which occur in 
a living tissue when it is injured, provided that the injury is 
not of such a degree as to at once destroy its structure and 
vitality." (Burdon Sanderson.) 

Inflammation may extend by continuity, by contiguity, 
through the blood vessels, and through the lymphatics. 

Inflammation may terminate by resolution, retrogression, 
suppuration, ulceration, or gangrene. 

State the distinction between the antiseptic and aseptic 
wound treatment. 

In antiseptic wound treatment an effort is made to destroy 
the germs in a wound, as well as to prevent the entrance of 
more bacteria. The greatest reliance is placed upon chemical 
agents. 

(335) 



336 SURGERY. 

In aseptic wound treatment an effort is made to prevent the 
entrance of germs into a wound. The greatest reliance is 
placed upon mechanical purification and upon sterilization 
by heat. 

Mention the general characteristics of a benign tumor 
as distinguished from a malignant tumor. 

Benign tumors, in contradistinction to malignant tumors, 
are usually encapsulated, grow slowly, do not infiltrate, are 
not painful (except by pressure), do not give metastasis, do 
not recur upon removal, produce no cachexia, and do not cause 
death (except by location). 

What are the indications for ligature of the lingual 
artery? Give the steps of the operation, omitting aseptic 
details. 

The lingual artery is most frequently tied as a preliminary 
procedure to removal of the tongue. Other indications for 
its ligation are to control hemorrhage from the artery or its 
branches, to check the growth of advanced carcinoma of the 
tongue, and certain cases of macroglossia. 

The patient should be on his back, his shoulders raised, and 
his head extended and turned to the opposite side. Starting 
just below the symphysis of the chin, an incision is made 
which passes downward and outward to the greater cornu of 
the hyoid bone, and then upward to the angle of the jaw, 
ending at about the level of commencement of the incision, 
but not endangering the facial artery. This incision divides 
the integument, both layers of the superficial fascia with the 
enclosed platysma, and exposes a portion of the submaxillary 
gland. The deep fascia covering the submaxillary gland is 
now incised and the gland loosened and held up by a retractor. 
We have now exposed Lesser 's triangle, formed by the hypo- 
glossal nerve above and the two bellies of the digastric muscle 
below. The floor of this triangle is formed by the hyoglossus 
muscle. The stylo-hyoid and the tendon of the digastric are 
now drawn downward, the lingual vein and the hypoglossal 
nerve are drawn upward, and an incision is carefully made 



SURGERY. 337 

through the hyoglossus muscle just above the hyoid bone. In 
making this last incision, which exposes the artery, care must 
be taken to avoid wounding the middle constrictor and con- 
sequently opening the pharynx. The submaxillary gland 
and its duct must also be protected from injury lest a salivary 
fistula result. The aneurism needle is now passed about the 
artery, the ligature tied, the external wound sutured, and an 
aseptic dressing applied. The artery may also be secured 
before it passes beneath the hyoglossus, and the danger of 
opening the pharynx is thus greatly lessened. 

Name the different varieties of malignant tumors. 

Sarcoma (round, spindle, and giant-cell, melanotic, alve- 
olar, lympho-sarcoma, and endothelioma) and carcinoma 
(epithelioma, scirrhus, encephaloid, melanotic, and colloid). 

What are the chief affections of the scrotum? 

Intertrigo, eczema, erysipelas, ecchymosis, edema, chancre, 
chancroid, syphilitic eruptions, tubercular ulceration, ele- 
phantiasis (lymph-scrotum), urinary fistula, tubercular si- 
nuses, gangrene, lipoma, sebaceous cyst, and epithelioma. 

What other methods beside the use of the knife are 
employed to remove a carcinoma from superficial surfaces? 

Caustics and the X-rays. 

Name the principal operations for stone in the bladder. 

Perineal lithotomy, supra-pubic lithotomy, and litholapaxy. 

Name the different varieties of benign tumors. 

Lipoma, fibroma, chondroma, osteoma, glioma, myxoma, 
angioma, lymphangioma, myoma, neuroma, adenoma, and 
papilloma. 

Relate the causes of intestinal obstruction. 

Acute obstruction : 1. Strangulation by bands, adhesions 
or apertures; 2. Volvulus; 3. Impaction of foreign bodies; 
4. Kinking of the gut (rare) ; 5. Acute intussusception; 6. 
The termination of a chronic obstruction. 
22 



338 SURGERY. 

Chronic obstruction : 1. Impaction of feces, gall-stones, for- 
eign bodies; 2. Intestinal affections, such as stricture, tumors, 
angulation of the gut from contraction of adhesions, matting 
together of intestinal coils; 3. Compression of the intestine 
by tumors or exudates outside of the bowel. 

Describe the ligation of the femoral artery at any 
selected point. 

Ligation at the apex of Scarpa's triangle. The line of the 
artery is from a point midway between the anterior superior 
spine of the ilium and the symphysis pubis to the adductor 
tubercle on the inner condyle of the femur. The patient 
should be on his back, with the thigh abducted, rotated out- 
ward, and slightly flexed. After all aseptic details have been 
carried out, an incision is commenced three inches below Pou- 
part's ligament and carried downward for about three inches 
in the line of the artery, dividing the skin, superficial fascia, 
and fascia lata. If the lymphatic glands are exposed they 
may be held to one side or removed. In making the incision 
the internal saphenous vein should not be wounded. The 
sartorius muscle should now be located, and beneath this mus- 
cle the artery will be found. Eemember that the fibers of the 
sartorius run downward and inward, while those of the 
adductor longus run downward and outward. The sheath 
should be opened upon the outer side and the crural branch 
of the genito-crural nerve and the long saphenous nerve 
avoided. The aneurysm needle is to be passed from within 
outward. The cutaneous wound is then sutured and asep- 
tic dressing applied. 

What are the chief surgical diseases of the groin? 

Inguinal hernia, femoral hernia, lymphadenitis, and en- 
cysted hydrocele of the cord. Psoas abscess, hip disease, and 
pelvic abscess may give rise to swellings, which are first 
observed in the groin. 

How are wounds classified? 

Incised, lacerated, contused, punctured, poisoned, and gun- 



SURGERY. 339 

shot. They may also be divided into septic and aseptic, 
Wonnds in the vicinity of great serous cavities are divided 
into penetrating and non-penetrating. Wounds are also 
spoken of as being either subcutaneous or open. 

Describe the anastomosis which takes place after liga= 
tion of the femoral artery at its middle third. 

The profunda femoris anastomoses with the articular 
branches of the popliteal and with the tibial recurrent; the 
comes nervi ischiadici anastomoses with the perforating 
branches of the profunda femoris and with the articular 
branches of the popliteal and tibial recurrent. 

Where should the opening be made in order to reach the 
antrum in a case of abscess of the middle ear? 

In the posterior superior angle of the suprameatal triangle 
of Macewen, which is bounded above by the posterior root of 
the zygoma, in front by the upper and posterior segment of 
the osseous external meatus, and behind by a line drawn tan- 
gent to the bony meatus and almost at right angles to the 
posterior root of the zygoma. The chisel is to be directed 
slightly forward to avoid wounding the sigmoid sinus, and 
care should be taken to avoid injury to the facial nerve. 

What agents are employed for the production of local 
anesthesia? 

Ice and salt, carbolic acid, ethyl chloride, cocaine (intra- 
dermic, infiltration, perineural and paraneural methods) 7 
eucaine, and nirvanin. 

What are the causes of secondary hemorrhage? 

Chief cause : Septic arteritis. 

Contributory causes: 1. Early absorption of ligature; 2. 
Faulty application of ligature; 3. Ligature too near a col- 
lateral branch; 4. A diseased condition of the arterial wall; 
5. A state of the blood unfavorable to wound repair (albu- 
minuria or diabetes) ; 6. Increased blood pressure (plethora, 
Bright 's disease, fever, excitement, injudicious administra- 
tion of stimulants). 



340 SURGERY. 

What are the causes of esophageal stricture? 

Congenital narrowing, the cicatricial contraction of healed 
ulcers (due to the ingestion of corrosive liquids or to syphilis) , 
carcinoma, polypoid tumors projecting from the mucosa, and 
external pressure (aneurism, goitre, sarcoma of glands or of 
vertebrae, pericardial effusion). Strictures near the cardiac 
orifice may arise from the healing and contraction of a gastric 
ulcer. 

At what point is paracentesis thoracis preferably per= 
formed? 

At the most dependent point of the effusion. The site 
usually selected is in the seventh or eighth interspace just 
below the angle of the scapula or in the posterior axillary line. 

What are the predisposing and what are the exciting 
causes of abdominal hernia? 

Predisposing causes: Early life, male sex, occupations de- 
manding great muscular exertion, structural defects (elonga- 
tion of the mesentery, a patent funicular process), heredity, 
relaxation of the abdominal wall from disease, weakening of 
certain portions of the abdominal wall by injury or operation, 
phimosis, pertussis, bronchitis, urethral stricture and consti- 
pation. 

Exciting cause: Any increase of the intra-abdominal pres- 
sure. 

What are angiomata? 

Angiomata are tumors composed of blood vessels, some of 
which are of new formation. 

Define volvulus and give its treatment. 

By volvulus is meant a twisting of the gut in such a manner 
that the intestinal lumen is occluded and the circulation of 
the bowel affected. Treatment : Celiotomy. An attempt may 
be made to untwist the intestine, but this is usually impos- 
sible. If the attempt succeeds a recurrence of the condition 
should be guarded against by shortening the mesentery. If 
the attempt fails one of three courses may be pursued : 



SURGERY. 341 

1. An anastomosis may be performed between the bowel 
above and that below the volvulus. 

2. Resection of the portion of intestine involved, followed 
by circular enterorrhaphy. 

3. The making of an artificial anus. If the large intestine 
is involved, as is usually the case, the latter course is prob- 
ably the best one. 

What is an abscess? 

An abscess is a circumscribed collection of pus in a cavity 
of abnormal formation. 

How does a carbuncle differ from a furuncle? 

A carbuncle is a gangrenous inflammation commencing in 
the subcutaneous tissues and extending to the skin. Car- 
buncles are usually single, occur most commonly after middle 
life, show a predilection for the back of the neck or inter- 
scapular region, and discharge through more than one open- 
ing. They are larger, flatter, and accompanied by greater 
constitutional disturbances than are furuncles. 

A furuncle is a gangrenous inflammation commencing in 
the skin and extending to the subcutaneous tissues. Fur- 
uncles are usually multiple, occur most commonly during 
adolescence and early adult life, show no predilection for any 
portion of the body, and discharge through a single central 
opening. They are smaller, more conical, and accompanied 
by less constitutional disturbance than are carbuncles. 

What anesthetic would you select for an operation about 
the mouth? 

Chloroform, unless contra-indicated. 
What is an adenoma? 

An adenoma is a tumor, the minute structure of which re- 
sembles that of a gland. Unlike normal glands, these tumors 
have no secretory ducts and no physiologic function. 

Through what channels is carcinoma disseminated? 

Through the lymphatic channels. 



342 SURGERY. 

Describe a dissecting aneurysm. 

A dissecting aneurysm is one in which the blood breaks 
through an atheromatous ulcer in the intima and burrows its 
way through the substance of the media ; the sac of the aneu- 
rysm is formed within the wall of the vessel. 

What are the varieties of hydrocele? 

Hydroceles of the cord: 1. Diffuse; 2. Encysted. 

Hydroceles of the testicle: 1. Vaginal; 2. Congenital; 3. 
Infantile; 4. Hydrocele of the funicular process (lower por- 
tion) ; 5. Encysted ; 6. Hydrocele of a hernial sac. 

Enumerate the diagnostic points in intussusception. 

Colicky abdominal pain, vomiting, tenesmus, the passage 
of blood-stained mucus or pure blood, and the presence of a 
sausage-shaped tumor, which usually is situated in the line 
of the colon, an absence of resistance being observed in the 
iliac fossa. In advanced cases rectal examination may reveal 
the presence of the intussusceptum. Acute intussusception 
is more common in early childhood; chronic intussusception 
is more frequently observed in adults. 

What structures are divided in the operation for stran- 
gulated femoral hernia? 

Skin, superficial layer of superficial fascia, cribriform fas- 
cia, femoral sheath, septum crurale, subserous areolar tissue, 
parietal peritoneum, and the seat of constriction, which is 
practically always the lunated edge of Gimbernat's ligament. 
The superficial external pudic artery is always cut "and the 
superficial epigastric is usually divided. 

With what conditions may aneurysm be confounded? 

Abscesses, tumors and cysts which are situated near a blood- 
vessel, and pulsating tumors of bone. 

Where is the swelling and fluctuation most prominent 
in synovitis of the ankle joint? 

At both sides of the tendo Achillis and in front of both 
malleoli (between the external malleolus and the extensor 



SURGERY. 343 

communis digitorum tendons and between the internal mal- 
leolus and the tibialis anticus tendon). 

Give a classification, either original or from competent 
authority, of burns. 

Dupuytren's classification is the best. He divided all burns 
into six classes or degrees: 1. Superficial burns followed by 
redness and desquamation of the epidermis; 2. Burns fol- 
lowed by the formation of vesicles or bullae; 3. Burns de- 
stroying the cuticle and a portion of the true skin; 4. Burns 
extending into the subcutaneous areolar tissue; 5. Burns 
involving deeper structures, such as muscles and tendons; 6. 
Burns involving all of the constituents of the part. 

Define an acute and a chronic abscess. 

An acute abscess is one which develops with all the signs 
and symptoms of inflammation. It contains pus. 

A chronic abscess is one which is formed without the signs 
and symptoms of inflammation. As a rule they are tuber- 
cular, and do not contain true pus unless a mixed infection 
has occurred. 

Mention the causes of dislocation. Give the cardinal 
symptoms of dislocation. 

Predisposing causes : 1. The anatomic peculiarities of the 
joint; 2. The situation of the joint; 3. Active adult life; 4. 
The male sex. 

Exciting causes: 1. External violence (direct or indirect) ; 
2. Muscular action. 

Symptoms: 1. An alteration in the shape of the joint, the 
displaced articular extremity being frequently felt in an 
abnormal position; 2. An alteration in the length of the 
affected member (shortening or elongation) ; 3. More or less 
immobility of the affected joint ; 4. An alteration in the direc- 
tion of the axis of the extremity. 

Dislocations, like fractures, are usually accompanied by 
pain, swelling and ecchymosis. 



344 SURGERY. 

How are amputations classified in regard to time of 
operating? What period is most favorable for operation? 

Primary; the amputation is performed before the develop- 
ment of inflammation. 

Intermediate; the amputation is performed during the ex- 
istence of active inflammation. 

Secondary; the amputation is performed after the subsi- 
dence of the inflammatory phenomena. 

The primary period is the one most favorable for operation. 

Under what circumstances should an artery be ligated 
in its continuity? What instruments are required for the 
operation? 

An artery should be ligated in its continuity to check 
hemorrhage, to promote the cure of an aneurysm, to diminish 
the rate of growth of a tumor, to reduce the blood supply of 
an organ, and as a preliminary step to the removal of some 
vascular structure (such as the tongue) . The instruments re- 
quired are a scalpel, dissecting forceps, retractors, a grooved 
director, several hemostats, an aneurysm needle, ligatures, nee- 
dles, and sutures. 

What are the causes of stricture of the rectum? 

Congenital malformation, syphilis, carcinoma, dysentery, 
tuberculosis, gonorrhea, traumatism or operations involving 
the greater portion of the circumference of the bowel, repeated 
attacks of inflamed hemorrhoids, chronic proctitis, inflam- 
matory thickening outside of the gut, as in cases of pelvic 
cellulitis after labor, and tumors pressing upon the rectum 
and narrowing its lumen. 

Define nephrorrhaphy, nephrotomy, nephrectomy. Give 
an indication for the performance of each. 

By nephrorrhaphy is meant the stitching of a kidney to the 
posterior wall of the abdomen. Indication, floating kidney. 

By nephrotomy is meant the cutting into kidney. Indi- 
cation, renal calculus. 



SURGERY. 345 

By nephrectomy is meant the excision of a kidney. Indi- 
cation, a primary malignant renal growth. 

Name the methods of inflating the tympanum. 

Valsalva's, Politzer's, and by means of the Eustachian 
catheter. 

What are the conditions which render excision of the 
lower jaw advisable? 

Malignant tumors of the mandible, malignant tumors in 
the adjacent tissues involving the bone secondarily, trau- 
matism, and necrosis may render excision advisable. 

What are the complications of dislocation of the hip? 

Fracture of the acetabulum (with or without injury to the 
pelvic viscera), fracture of some portion of the upper ex- 
tremity of the femur, rupture of the femoral artery, paralysis 
from compression or rupture of a nerve-trunk, and extensive 
laceration of the neighboring soft parts. 

What arteries need ligating in amputation at the middle 
third of the leg? Describe your method of ligating. 

The anterior tibial, the posterior tibial, and the peroneal. 
The anterior tibial artery will be found just above the inter- 
osseous membrane lying between the tibialis anticus and the 
extensor proprius hallucis. The artery should be freed from 
the surrounding structures and ligated separately or to- 
gether with the two venae comites, care being taken not to 
include the anterior tibial nerve. If the artery cannot be 
reached owing to excessive retraction, the patient should be 
turned on his face, when the weight of the stump will extend 
the limb and make the vessel much easier of access. The pos- 
terior tibial will be found behind the tibia lying upon the 
flexor longus digitorum or between it and the tibialis pos- 
ticus. It should be freed from surrounding structures and 
ligated separately or together with its two venae comites; 
care must be taken not to include the posterior tibial nerve. 
The peroneal artery will be found behind the fibula between 



346 SURGERY. 

the tibialis posticus and flexor longus hallucis or surrounded 
by the fibres of the flexor longus hallucis. It should be freed 
from surrounding structures and ligated separately or to- 
gether with its two venae comites. Both the posterior tibial 
and the peroneal arteries will be found anterior to the deep 
transverse fascia of the leg. After these three arteries have 
been secured, the tourniquet should be loosened and any other 
bleeding point seized and tied. 

Where may a ligature be applied for aneurysm of the 
popliteal artery? 

Preferably at the apex of Scarpa's triangle or in Hunter's 
canal. It may also be applied in the upper portion of the 
popliteal space, just after the passage of the artery through 
the opening in the adductor magnus. 

What are the indications for litholapaxy (rapid litho= 
trity) as compared with (a) lateral perineal lithotomy; (b) 
median perineal lithotomy; (c) suprapubic lithotomy? 

Unless some contra-indication exists litholapaxy is the 
operation par excellence. The contra-indications are: 1. 
Encysted calculus (absolute contra-indication) ; 2. A stone 
larger than 1% inches in diameter, though many surgeons 
will crush much larger stones; 3. Stones consisting of calcium 
oxalate are so hard that the crushing operation is difficult 
and sometimes 4 impossible; 4. Excessive irritability of the 
urethra; 5. Urethral stricture of old standing not capable of 
dilatation or the existence of false passages; 6. Cystitis; 7. 
Enlarged prostate; 8. Sacculated or contracted bladder (hold- 
ing less than six ounces) ; 9. Extensive renal disease (unless 
there is no doubt that the operation may be quickly per- 
formed) . 

Lateral perineal lithotomy is indicated: 1. Where cystitis 
and great irritability of the bladder are present; 2. In phos- 
phatic concretions ; 3. If the bladder is contracted. 

Median perineal lithotomy is rarely performed, as the open- 
ing is much smaller than in the lateral operation. The 



SURGERY. 347 

advantages claimed for it are the small amount of hemor- 
rhage and the lessened danger of urinary infiltration and 
injury to the ejaculatory ducts. 

Suprapubic lithotomy is to be performed: 1. When the 
stone is too large to crush; 2. If the stone is encysted; 3. If 
old strictures or an enlarged prostate is present; 4. When the 
patient cannot assume the lithotomy position (ankylosis of 
left hip, rachitic contraction of pelvis, presence of a tumor) ; 
5. When the crushing operation is not deemed advisable in 
young boys. 

The indications for the suprapubic operation have been 
greatly extended in recent years at the expense of the perineal 
method. The only two absolute contra-indications to the 
procedure are severe septic cystitis and contraction of the 
bladder. 

What fractures do not present mobility? Under what 
circumstances is crepitus absent? 

Impacted fractures and incomplete fractures do not present 
preternatural mobility. 

Crepitus is absent in impacted fractures, in incomplete 
fractures where there is great separation or over-riding of 
the fragments, and where portions of muscle, tendon, or peri- 
osteum are between the fragments. 

What symptoms follow division of the radial nerve? 

Anesthesia over the radial side of the dorsal surface of the 
wrist and hand and over the dorsal surface of the thumb, 
index, middle, and radial half of ring fingers, excepting over 
the terminal phalanges. 

What conditions of the kidneys require nephrectomy? 

Any of the following conditions may require nephrectomy: 
Carcinoma, sarcoma, tuberculosis, calculous pyonephrosis, 
hydronephrosis, traumatic lesions (particularly if compli- 
cated by laceration of the peritoneum), and some cases of 
ruptured ureter. 



348 SURGERY. 

How may a quart of normal salt solution be prepared at 
the patient's home? 

By dissolving two teaspoonfuls of salt in a quart of water. 
The solution may be sterilized by boiling. The percentage of 
salt is not accurate, but it is near enough for practical pur- 
poses. 

What are the principal affections of synovial bursae? 

Acute simple bursitis, acute suppurative bursitis, chronic 
fibroid bursitis, chronic bursitis with effusion (house-maid's 
knee), chronic tuberculous bursitis, syphilitic and gouty de- 
posits. 

What muscles are divided in the operation for (a) di= 
verging strabismus, (b) converging strabismus? 

(a) The external rectus, (b) The internal rectus. 

How would you reduce a dislocation of the inferior 
maxillary bone? 

It is only necessary to depress the condyle below the level 
of the eminentia articularis, when the masseter, temporal and 
internal pterygoid muscles will readily draw it back into the 
glenoid cavity. The patient is to be seated, the surgeon 
stands in front of the patient and presses down upon the 
molar teeth with his two thumbs, which are guarded by a 
towel. This pressure is continued in a downward and back- 
ward direction until the condyle clears the eminentia articu- 
laris, when the chin is to be raised by the fingers. The jaw 
should be kept at rest for four or five days by a Barton 
bandage. 

Name the varieties of shoulder=joint dislocations. 

Anterior (subcoracoid, intracoracoid, subclavicular), down- 
ward (subglenoid, erecta), posterior (subacromial, subspi- 
nous), and upward (supraglenoid). 

What are the possible mechanical obstructions in the 
reduction of fractures? 

Muscular spasm, the interposition of muscle or periosteum 



SURGERY. 349 

between the ends of the fragments, impaction of the frag- 
ments, perforation of the skin by one of the fragments, and 
effusion into a joint (in fracture of patella or of olecranon). 

What are the sources of wound infection? 

A wound may be infected by the foreign body making the 
wound, by any foreign substance or fluid coming in contact 
with the wound, by the blood, by the skin of the patient, by 
the hands of the surgeon and assistants, and by instruments, 
ligatures, sutures or dressings. Aerial infection is very rare, 
though possible. 

Relate the difference between a sinus and a fistula. 

A sinus is an abnormal canal leading from the skin or 
mucous membrane to an abnormal cavity. It has but one 
opening. 

A fistula is an abnormal communication between the skin 
or mucous membrane and a normal cavity. It has two open- 
ings. 

Define pyemia and give its symptoms. 

By pyemia is meant a general infection of the blood with 
pyogenic organisms. It is septicemia plus metastatic ab- 
scesses. 

Symptoms: Repeated rigors with a markedly remittent 
temperature, exhausting diaphoresis, hyperesthesia of the 
skin, suppuration in joints not usually involved in other 
febrile affections (sterno- clavicular, sacro-iliac), and diar- 
rhea. If there is an open wound it will become dry and 
glazed. Physical examination will reveal the signs of pulmo- 
nary congestion or pneumonia, metastatic abscesses may be 
detected in various portions of the body, and examinations 
of the blood show a leukocytosis. The mind is usually clear. 
Toward the termination of the affection the patient may fall 
into the typhoid state. 

What are the indications for castration? 

Castration may be performed for malposition, for tuber- 
culous disease, for old standing hematoceles, for simple or 



350 SURGERY. 

malignant tumors, after some injuries, and for chronic en- 
largement of the prostate. 

Give the causes and sequelae of suppurative middle ear 
disease. 

Causes: Inflammations in the naso-pharynx and infected 
wounds of the membrana tympani. 

Sequelae : These may be divided into the extracranial, cra- 
nial and intracranial. 

Extracranial: Eczema of meatus, furuncles of meatus, sub- 
periosteal abscess and necrosis of tympanic plate. 

Cranial: Necrosis of ossicles, caries or necrosis of temporal 
bone, polypi, facial paralysis and mastoiditis. 

Intracranial : Extradural abscess, localized or diffused men- 
ingitis, thrombosis of the lateral sinus, and cerebral or cere- 
bellar abscess. Remember that 50 per cent, of all cases of 
brain abscess are due to this cause. 

State the causes of exophthalmos. 

Paralysis of the third cranial nerve, intra-orbital aneurysm, 
intra-orbital tumors, thrombosis of cavernous sinus, fracture 
of anterior fossa with laceration of cavernous sinus, em- 
pyema of the antrum, tumors of the antrum, and exoph- 
thalmic goitre. 

What are gliomata and where are they found? 

Gliomata are tumors composed of neuroglia. They occur in 
the brain, spinal cord, and rarely in the cranial nerves. The 
so-called glioma of the eye-ball is really a sarcoma. 

Mention obstacles to reduction of dislocations. 

Muscular resistance, anatomical peculiarities of the joint, 
the interposition of shreds of the capsular ligament, fracture 
of the bone involved, and the presence of adhesions (old dis- 
locations) . 

Define torticollis. Give the differential diagnosis of 
torticollis and cervical caries. 

Torticollis or wry-neck is a deformity due to contraction of 



SURGERY. 351 

certain muscles on one side of the neck. The sterno-mastoid 
is first affected, but the trapezius, the splenius, the platysrna, 
and even the cervical fascia may be involved. 

In cervical caries motion in all directions is restricted, and 
pain is elicited by pressing upon the cervical vertebrae; in 
torticollis motion is restricted in but one direction, that in 
which the muscle involved is put upon the stretch. 

Describe hypospadias, epispadias, phimosis, and para= 
phimosis. 

Hypospadias is a malformation in which the urethra opens 
upon the under surface of the penis. 

Epispadias is a malformation in which the urethra is par- 
tially or wholly exposed on the upper surface of the penis. 

Phimosis is that condition in which the prepuce is elon- 
gated, and in which the preputial orifice is so narrow that it 
can not be retracted behind the corona glandis. 

By paraphimosis is meant a strangulation of the glans penis 
by a prepuce which has been forcibly retracted and cannot be 
replaced. 

What is genu valgum? State how genu valgum should 
be treated. 

Genu valgum or knock-knee is a deformity in which there 
is an abduction of the legs from the median line, together 
with a certain amount of external rotation. The two inner 
condyles may be brought into apposition, while the two inter- 
nal malleoli are separated. Young children (up to the fifth 
or sixth year) in whom the deformity is not great may be 
treated by mechanical appliances. If due to rickets appro- 
priate constitutional treatment must be observed. When the 
deformity is great and the age of the patient precludes the 
hope of a cure by mechanical means, osteotomy is indicated. 
The best method of performing osteotomy is that of Macewen. 

What are the symptoms when the ulnar nerve has been 
divided on a level with the pisiform bone? 

Loss of adduction and abduction of the fingers, flexion of 



352 SURGERY. 

the last two phalanges of each finger, and hyper-extension at 
the metacarpophalangeal joint ("claw-hand")- The inter- 
osseous spaces become very marked from the atrophy of the 
muscles involved (the two inner lumbricales and all of the 
interossei). There is, also a paralysis of the short muscles 
of the little finger, of some of the thumb muscles (adductor 
transversus, adductor obliquus, and part of flexor brevis pol- 
licis), and of the palmaris brevis. There is anesthesia of the 
ulnar side of the dorsum and palm of the hand, and of both 
dorsal and palmar surfaces of the little and ulnar side of the 
ring fingers. 

What tissues are divided in the operation for oblique 
inguinal hernia? 

Skin, superficial fascia, intercolumnar fascia, cremaster 
muscle, infundibuliform fascia, subserous areolar tissue, and 
parietal peritoneum. The superficial epigastric and the 
superficial external pudic arteries are always divided. 

What are the indications for the operation of gastros= 
tomy? 

Malignant disease of the esophagus and stricture or stenosis 
of the esophagus from any cause, when the patient is unable 
to take sufficient nourishment. 

What is the differential diagnosis between septicemia 
and pyemia? 

Septicemia occurs before the advent of suppuration, re- 
peated rigors and metastatic abscesses are absent, and the 
patient is delirious. 

Pyemia occurs after the advent of suppuration, repeated 
rigors and metastatic abscesses are present, and delirium, if 
present at all, is apt to be nocturnal. 

A differential diagnosis is frequently impossible, but the- 
oretically the points given above are those to be expected. 

Give the differential diagnosis between sacroiliac dis= 
ease and morbus coxarius. 

In sacro-iliac disease pressure upon the crests of the ilia 



SURGERY. 353 

causes pain; if the pelvis be supported, the thigh may be 
moved in all directions without much discomfort; apparent 
or real shortening of the lower extremity is never present. 

In morbus coxarius pressure upon the crests of the ilia 
produces no pain; motion of the thigh is accompanied by 
pain; apparent or real shortening of the lower extremity is 
always present at some stage of the affection. 

What are the principal affections of muscles? 

Contusion, sprain, rupture of sheath, rupture of muscle or 
tendon, displacement of tendon, myositis (traumatic, rheu- 
matic, acute suppurative, tubercular, syphilitic, parasitic, and 
myositis ossificans), primary tumors (angioma, fibroma, 
chondroma, myxoma, and sarcoma), and secondary tumors 
(carcinoma and sarcoma). 

Give the indications and methods for ligature of the 
common carotid artery. 

The common carotid artery is tied for aneurysm, for wounds 
of the internal or external carotid artery or their branches, 
to check malignant growths, and as a preparatory procedure 
to the removal of tumors. 

Ligation in superior carotid triangle. The patient should 
be on his back with his shoulder elevated, the head thrown 
back, and the face turned slightly to the opposite side. After 
all aseptic precautions have been carried out an incision three 
inches in length is made in the line of the artery (from the 
sterno-clavicular articulation to a point midway between the 
angle of the jaw and the mastoid process), the center of the 
incision being opposite the cricoid cartilage. The skin, super- 
ficial fascia, platysma myoides, and superficial layer of the 
deep fascia are to be divided, the sterno-mastoid muscle drawn 
outward, the tendon of the omo-hyoid drawn downward, and 
the pulsations of the artery sought for beneath the sterno- 
mastoid. The sheath is now opened upon the inner side, the 
aneurysm needle is passed from without inward, threaded, 
and withdrawn. 
23 



354 SURGERY. 

Ligation in inferior carotid triangle. Patient in same 
position as before. The incision is made in the line of the 
artery from the level of the cricoid cartilage to the sterno- 
clavicular articulation, and divides skin, superficial fascia, 
platysma, and superficial vessels and nerves. The superficial 
layer of the deep cervical fascia is then divided, the sterno- 
mastoid muscle drawn outward, and the sterno-hyoid and 
sterno-thyroid muscles drawn inward. The sheath is opened 
upon the inner side, and the aneurysm needle passed from 
without inward. 

What operations are performed for intractable neural= 
gia of the fifth nerve? 

Neurotomy, nerve stretching, removal of Meckel's ganglion, 
neurectomy, and removal of the Gasserian ganglion. Accord- 
ing to the symptoms, one or more of the following nerves may 
be resected: Supra-orbital, supra- trochlear, infra-orbital, in- 
ferior maxillary division of the fifth, lingual, inferior dental, 
and mental. 

State the most common seat of fracture of the clavicle 
and describe a method of treatment. 

At the outer end of the middle third of the bone. 

Sayre's method. Three strips of adhesive plaster three and 
one-half inches wide and long enough to encircle the chest and 
arm are required. A loop is made in the end of the first strip ; 
this loop is secured by stitches and made to encircle the arm 
close to the axilla, the non-adhesive surface of the plaster 
being next to the skin. The shoulder is then drawn backwards 
and the adhesive strip carried around the chest from behind 
forward (adhesive surface next to skin), passing over the 
front of the chest, under the axilla, and finally attached to the 
part crossing the back. The elbow of -the injured side is now 
brought forward and the hand placed upon the sound shoul- 
der. As the loop of the first strip acts as a fulcrum, the shoul- 
der and outer extremity of the clavicle are carried backward. 
With the arm in this positiqn the end of the second strip is 



SURGERY. 355 

fixed to the sound shoulder, and the strip is then brought 
downwards across the back to the elbow of the injured side 
(a hole being cut in the plaster to accommodate the olecra- 
non), upwards across the front of the chest and forearm, and 
fastened to the other end over the top of the sound shoulder. 
This strip holds the shoulder back and keeps it raised. The 
third strip is passed horizontally about the chest and forearm 
to hold the extremity against the body. A towel should be 
placed in the axilla, and all contiguous cutaneous surfaces 
should be separated by pieces of lint. This position is to be 
maintained until union occurs (about three or four weeks), 
and the movements of the arm should be restricted for a week 
or so longer. 

Give the causes of atrophy. 

Causes: 1. Diminished functional activity; 2. Defective 
nutrition; 3. Pressure; 4. Nervous influence (neuropathic 
atrophy) ; 5. Senility. 

What symptoms follow division of the facial nerve? 

Paralysis of the same side of the face without implication 
of palate or uvula (it is presumed that the nerve has been 
divided after its exit from the skull) . The paralyzed side of 
the face is immobile, devoid of expression, and the natural 
folds and wrinkles are obscured. The eye-lids cannot be 
completely closed, the eye-ball rolling upward and outward 
when forcible closure is attempted. Epiphora is present 
from the drooping of the lower lid. The lips cannot be 
firmly closed, and whistling is impossible. If attempts are 
made to move the face (to show the teeth or laugh) marked 
asymmetry is produced, the face being drawn toward the 
non-paralyzed side. Owing to the paralysis of the bucci- 
nator, food collects between the teeth and the cheek. 

What method of treatment affords the most prompt 
relief in paronychia? 

Evacuation of the pus or inflammatory exudate by means 
of an incision, the introduction of a small strip of iodoform 



356 SURGERY. 

gauze for drainage, and the application of a moist antiseptic 
dressing. 

Describe the operation for ligature of the subclavian 
artery in its second part. 

The patient should be in the dorsal position, with a cushion 
beneath the shoulders, face turned to the opposite side, and 
the shoulder depressed. After all aseptic precautions have 
been carried out, the skin should be drawn down over the 
clavicle, and an incision made over the bone extending from 
the middle of the clavicle almost to the sterno-clavicular 
articulation. The skin is then allowed to retract, and the 
wound will be half an inch above the clavicle. This incision 
divides the skin, superficial fascia, platysma myoides, and the 
superficial layer of the deep cervical fascia. The clavicular 
head of the sterno-mastoid muscle should then be divided, 
and any veins overlying the prevertebral fascia covering the 
scalenus anticus ligated. The prevertebral fascia is then 
incised, the phrenic nerve drawn inward, and the outer two- 
thirds of the anterior scalenus muscle divided close to its 
attachment to the first rib. Care must be taken not to wound 
the anterior jugular, external jugular, internal jugular or 
subclavian veins, the phrenic nerve or the pleura. The needle 
is passed from before backward and from below upward. 

What are the varieties of ankylosis? 

Incomplete or fibrous and complete or bony. Ankylosis is 
also spoken of as being either true (involvement of articular 
structures) or false (result of extra-articular lesions). 

When is operative interference advisable in the treat= 
ment of malignant tumors? 

Operative interference is advisable when the tumor can be 
thoroughly removed, when the operation will diminish pain 
or make the patient more comfortable, and when it will 
lengthen the life of the patient. 



SURGERY. 



357 



Define peritonitis. State three ways in which the peri* 
toneum may be invaded by bacteria. 

By peritonitis is meant an inflammation of the peritoneum. 
Bacteria may invade the peritoneum through the wall of the 
intestine, through a wound in the abdominal wall, or through 
a perforating ulcer of the stomach. 

What is the treatment for stenosis of the lachrymal 
duct? 

Dilatation by means of lachrymal probes. The passage of 
the larger probes is preceded by division of the lower canali- 
culus. If the stenosis is simply due to tumefaction of the 
mucous membrane (as in the new-born) it may yield to 
medicinal agents. 

What are the causes of ischiorectal abscess? 

Infection of the ischio-rectal areolar tissue with pyogenic 
organisms from the perineum or rectum, injuries to the peri- 
neum or rectum, and exposure to cold or wet. Suppuration 
in the ischio-rectal fossa may also be due to disease of adja- 
cent or distant structures (sacro-iliac or hip joints, pelvic 
bones, spine, prostate). 

Give an operation for excision of the tongue for car= 
cinoma. 

Kocher's operation. After all aseptic precautions have 
been carried out, tracheotomy is performed, a well-fitting 
canula is introduced, and the pharynx packed with a carbol- 
ized sponge which has a cord attached to it. The incision 
commences near the lobule of the ear, passes down the ante- 
rior border of the sterno-mastoid muscle to its middle, along 
the hyoid bone to near the median line, and then upwards to 
the symphysis. This flap of skin and subcutaneous tissue is 
dissected up and held out of the way by a retractor. All the 
lymphatic glands in the submaxillary triangle are removed, 
as well as the submaxillary (and if necessary the sublingual) 
salivary gland, and the facial and lingual arteries are ligated 
close to the carotid. If any portion of the mandible is dis- 



358 SURGERY, 

eased it may be removed by enlarging the wound. The oppo- 
site lingual artery is now tied through a separate incision. 
The mylo-hyoid muscle and the reflection of the oral mucous 
membrane are then divided close to the alveolus, the tongue is 
drawn out through the wound and removed close to the epi- 
glottis behind and close to the hyoid bone below. The entire 
raw surface is now painted with Whitehead's varnish, the 
external incision is closed by sutures, excepting the lower- 
most portion, in which a drainage tube is inserted, an aseptic 
dressing is applied, and the sponge in the pharynx is replaced 
by gauze packing. 

How should ankylosis of the jaw be treated? 

By division of the neck of condyle, by excision of condyle, 
removal of the vertical ramus as far as the alveolar border, or 
by the excision of a wedge of bone (apex toward alveolar 
border) from the neighborhood of the angle, and the estab- 
lishment of an artificial joint in this situation (Esmarch's 
operation) . Excision of the condyle and Esmarch's operation 
are the measures usually employed. 

How should hemorrhage from the liver, occurring in the 
course of an operation, be controlled? 

By tamponing with iodoform gauze, by the thermo-cautery, 
by ligature, and by suture. 

Describe Pott's fracture of the lower extremity. 

By Pott's fracture is meant a fracture of the fibula about 
three inches above the tip of the malleolus. Dependent upon 
the amount of violence, there may co-exist one or more of the 
following lesions: 1. Rupture of the internal lateral ligament; 
2. Tearing off of the internal malleolus; 3. Fracture of the 
external portion of the articular surface of the tibia. The 
foot is practically always everted, and shows a tendency to 
slip backward. There are points of tenderness over the lines 
of fracture, the foot may be moved from side to side in the 
widened tibio-fibular mortise, and crepitus may be obtained. 



SURGERY. 359 

Give the general symptoms of brain tumor. 

Headache, pain upon percussion, vomiting, vertigo, epi- 
leptic convulsions, choked disc, and finally symptoms of com- 
pression. 

Describe an operation for the cure of webbed fingers. 

Didot's operation. After all aseptic precautions have been 
observed, a flap the length of the finger and half its width 
(plus the added width of the web) is taken from the dorsal 
surface of one finger and the palmar surface of the other. 
Each of these flaps is carefully applied to the denuded area 
upon the finger to which it is attached and secured by sutures. 

How is resection of the elbow joint performed? 

After all aseptic precautions have been observed, the fore- 
arm is flexed to a right angle and held across the chest of the 
patient by an assistant. A vertical incision five inches in 
length is now made along the back of the joint, the center of 
the incision being a line or two to the inner side of the tip of 
the olecranon. This incision goes down to the bone and di- 
vides the tendon of the triceps longitudinally. The tendon 
is then separated from the olecranon and this process cleared 
off, keeping the knife close to the bone to avoid wounding the 
ulnar nerve on the inner side and the extension of the triceps 
upon the outer side. The olecranon is now cut through and 
removed. "With the thumb in the wound to protect the soft 
parts, the structures are gradually separated from the internal 
condyle by the knife (cutting towards the bone) or periosteal 
elevator. In this manner the common flexor tendon is sepa- 
rated from the bone and the internal lateral ligament is di- 
vided. "The external condyle is now freed in a similar man- 
ner, and the end of the humerus is protruded through the 
wound by flexing the forearm until it touches the arm. The 
articular surface of the humerus is now sawn off, and if any 
carious areas are seen upon the surface of section they are to 
be thoroughly gouged out. The bones of the forearm are then 
forced through the wound and their cartilaginous surfaces 



360 SURGERY. 

removed. Care must be taken not to injure the insertions of 
the biceps and brachialis anticus. All diseased synovial mem- 
brane and granulation tissue must be dissected away, any ex- 
isting sinuses thoroughly curetted, and the parts flushed with 
an antiseptic solution. A drainage tube is inserted in the 
most dependent portion of the wound, sutures are introduced, 
and an aseptic dressing applied. 

Give the symptoms and treatment of naevus. 

Capillary naevus occurs in the form of a slightly elevated 
mass, which varies in color from purple to bright red, ac- 
cording to the relative amount of contained venous or arte- 
rial blood. These growths are congenital or occur soon after 
birth, they may be multiple, and rarely exceed an inch or two 
in diameter. They are usually found upon the neck or face. 
They may shrink and disappear, persist unchanged, or rapidly 
increase in size. Treatment: Excision or electrolysis. 

Cavernous naevus usually involves both skin and subcuta- 
neous connective tissue. It usually occurs as a lobulated 
bluish or dusky red swelling, soft to the touch, easily com- 
pressible, but refilling upon the removal of the pressure. 
Pulsation and bruit are usually absent. Treatment : Excision 
wherever practicable. Electrolysis when the growth cannot 
be excised. 

What is glaucoma? Give the treatment of glaucoma. 

Glaucoma is a disease of the eye characterized by increased 
intra-ocular tension, excavation of the optic disc, restriction 
of the field of vision, corneal anesthesia, colored halos about 
lights, and a diminution of visual power that may result in 
blindness. Treatment: Iridectomy. 

What is a tumor? 

A tumor is an atypical new growth which is not the result 
of inflammation. 

A tumor is an adventitious mass of tissue, differing from 
the tissue in which it grows in gross and minute structure, 
tending to unlimited growth, having no function, the nutri- 



SURGERY. 361 

tion of which is independent of the general nutrition of the 
body, showing no tendency to spontaneous cure, and not co- 
incident with nor dependent upon inflammation. 

Describe the following forms of sutures: Interrupted, 
button, continued, buried, secondary. 

The interrupted suture consists of a number of single 
stitches, each one being independent of its neighbor. 

The button suture is made by inserting a needle threaded 
with stout silver wire at some distance from the wound, carry- 
ing it deeply through the tissues and bringing it out at a cor- 
responding point on the opposite side of the wound. The 
suture is secured at both ends to a flat lead button, the wire 
being pulled as tight as is deemed advisable. 

In a continued suture the suture traverses the wound con- 
tinuously in the same direction, being tied only at the begin- 
ning and at the end. 

A buried suture is one completely covered by and not in- 
volving the skin. 

Secondary sutures are those which are introduced at some 
time (usually two or three days) subsequent to an operation. 

What are the causes of atony of the bladder? 

Chronic over-distension from obstructed outflow (enlarged 
prostate, stricture) , a single prolonged voluntary or involun- 
tary over-distension, cystitis (particularly when gonorrheal), 
senility, and infective fevers. 

What is the treatment of fracture united with deformity? 

Osteotomy or osteoclasis. If the deformity is not great no 
treatment may be required. 

Give the treatment for rattlesnake bite. 

If the bite has been received upon a limb, a ligature should 
be immediately thrown around the part above the wound and 
drawn tight enough to prevent the entrance of the venom 
into the circulation. The wounded area should then be freely 
excised and bleeding encouraged for a short time. If the 



362 SURGERY. 

bite is upon a portion of the body which cannot be constricted 
by a ligature the wound should be excised as before, or if this 
is impracticable vigorous suction of the wound should be 
made. In the case of an extremity the ligature is to be slack- 
ened at intervals to allow of the admission of any remaining 
poison by instalments. The injection about the wound of a 
1 per cent, aqueous solution of potassium permanganate has 
been highly recommended. Antivenene may also be em- 
ployed. The constitutional treatment consists of the free 
administration of alcohol and hypodermatic injections of 
strychnine. 

What circumstances demand amputation of an ex= 
tremity? 

Amputation is demanded : 1. To trim up a stump of a limb 
torn off by machinery, cut off by wheels of a railway train, 
or carried away by a cannon-ball ; 2. When the entire limb or 
one of its segments has been totally disorganized; 3. Where 
gangrene is imminent or has supervened (particularly if it is 
of the spreading type) ; 4. When marked symptoms of sepsis 
make their appearance or exhaustion supervenes from sup- 
puration, in a case where an unsuccessful attempt has been 
made to save a doubtful limb ; 5. In severe compound lacera- 
tions of the foot in old people, laying open the common syn- 
ovial cavity and involving the bones; 6. By primary malig- 
nant growths of bone (sarcoma). 

Amputation may be required for the relief of deformity, 
for the removal of benign growths (enchondroma of fingers), 
for laceration of the main artery of the limb, with other grave 
lesions of the soft parts, and in cases where the limb, if saved, 
would be of no practical use. 

Define the terms thrombus, phlebitis, and varix and give 
the causes of each. 

A thrombus is a clot of blood formed within the heart or 
blood-vessels. It is due to alterations in the blood current, 
changes in the vessel- walls, and alterations in the blood itself. 

By phlebitis is meant the inflammation of a vein. It may 



SURGERY. 363 

be due to injury of the coat of the vein, to the formation of a 
thrombus within the vein, to the extension of an inflammation 
from surrounding tissues, to gout, or to infection with pyo- 
genic organisms. 

By varix is meant a dilated, elongated, and more or less 
tortuous condition of a vein. It is due to increased pressure 
within the veins (long standing, habitual over-exertion, tight 
garters), obstruction or occlusion of the deeper veins, and to 
an abnormal communication with an artery (aneurysmal 
varix) . Inherited weakness and the relaxation of the system 
from sedentary habits are predisposing causes. 

Describe a chancroid. Give its usual symptoms and 
possible complications. 

A chancroid is an infectious venereal sore characterized by 
the absence of constitutional manifestations. It commences 
as a pustule or ulcer, is frequently multiple, is round, oval, 
or unsymmetrically irregular, is excavated or ' ' punched out, ' ' 
has a rough "worm-eaten" whitish-gray surface, secretes an 
abundant purulent discharge which is readily auto-inoculable, 
runs an irregular course, is painful, and usually responds to 
local treatment. The possible complications are phimosis, 
paraphimosis, lymphangitis, and bubo. 

What is a dislocation? Define the various kinds of 
dislocation. 

A dislocation is a displacement of one or more bones of a 
joint from its natural position. It is also the displacement 
of any organ from its natural position. 

Traumatic, due to violence or muscular action. 

Pathologic, due to disease. 

Congenital, due to an error of development, as a result of 
which a normal relation of the bony constituents has never 
existed. (The term "'Congenital dislocation" is a misnomer; 
it is a congenital malformation.) 

What are the methods of controlling hemorrhage? 

Exposure to air, cold, hot water, elevation, direct pressure, 



364 SURGERY. 

styptics, cauterization, acupressure, forcipressure, suture, 
torsion, and ligation. 

Define hypertrophy and give the causes. 

Hypertrophy is an increase in bulk of a tissue or organ 
occurring independently of the general growth of the body 
and without any structural change of the part affected. In 
a true hypertrophy the function is increased. 

Causes: Congenital predisposition, removal of pressure, 
direct stimulation or intermittent pressure, disturbances of 
nutrition, increased functional demand, and disturbances of 
the nervous system. 

Give the surgical palliative treatment of carcinoma of 
the stomach at the pylorus. 

Gastro-enterostomy, preferably by Von Hacker's method 
(posterior gastro-enterostomy) . 

Mention the causes of delayed union and give the treat- 
ment. 

The constitutional causes are general debility, osteomalacia, 
scurvy, syphilis, senility (?), pregnancy, and the cancerous 
cachexia. 

The local causes are faulty apposition, the interposition of 
fluid, muscle, or aponeurosis between the fragments, want of 
rest, defective blood supply, defective innervation, inflamma- 
tion on the surface of the limb, faulty treatment, and local 
affections of bone (malignant tumors, destruction of the peri- 
osteum by inflammation). 

Treatment: The removal of any local cause and the appro- 
priate remedies for the underlying constitutional disturbance. 
Change of air, tonics, regulation of the diet, and the adminis- 
tration of the mineral acids will frequently effect a speedy 
union. 

What glandular structures are most commonly affected 
in carcinoma of the anterior portion of the tongue? 

The submental lymphatic glands, the submaxillary lym- 



SURGERY. 365 

phatic glands, and probably those lying beneath the sterno- 
mastoid muscle. The sublingual and submaxillary salivary 
glands may also be involved. 

What are the causes of ptosis and the remedial meas= 
ures employed? 

Paralysis of the oculo-motor nerve or its supra-orbital 
branch (syphilis, rheumatism), and faulty development or 
injury of the levator palpebral 

Treatment: If due to syphilis or rheumatism the appro- 
priate constitutional treatment is to be instituted. In the 
absence of constitutional causes, operations are performed to 
increase the vicarious action of the frontalis muscle upon the 
upper lid (Panas). Wilder folds the tarso-orbital fascia upon 
itself and establishes a firm adhesion between the fascia and 
the frontalis muscle. If the action of the levator muscle is 
not entirely lost the principles of tendon advancement and 
tendon resection may be employed. (Everbusch, Snellen, 
Wolff.) 

What articular changes take place in dislocation? 
What are the general principles governing the treatment 
of dislocation? 

One or more of the ligaments and the capsule of the joint 
are torn and the mutual relations of the articular ends of the 
bones are changed. If the dislocation remains unreduced 
the cavity of the joint becomes filled with granulation tissue 
and the displaced and lacerated connective tissues become 
condensed about the head of the dislocated bone, sometimes 
forming a new capsule. Any irregularities of the dislocated 
bone become rounded off and it contracts adhesions to the 
surrounding tissues or forms a new joint by resting against 
a bony surface, its pressure stimulating the bone and peri- 
osteum to the production of an osseous ring about the point of 
contact, which possibly becomes covered with fibro-cartilage. 

Principles of treatment: Relaxation of the muscles about 
the joint, the reduction of the dislocation by causing the dislo- 
cated bone to enter the capsule through the same rent which 



366 SURGERY. 

it made upon leaving it (by manipulation, or by extension 
and counter-extension), the fixation of the parts after reduc- 
tion for a sufficient length of time, and subsequent passive 
and active motion. 

Define a fracture. Give the causes, symptoms, and 
varieties of fracture. 

A fracture is a sudden solution of continuity of a bone. 

Predisposing causes : Advancing age, male sex, and diseased 
conditions of the bone (atrophy, fragilitas ossium, rickets, 
sarcoma, secondary cancer). 

Exciting causes: Direct violence, indirect violence, and 
muscular action. 

Symptoms: A new point of motion (preternatural mobil- 
ity), crepitus, deformity from displacement, partial or com- 
plete loss of function, and signs of local trauma. 

Varieties: Complete and incomplete. Simple (subcutan- 
eous), compound (open), single, multiple, complicated, com- 
minuted, and impacted. Linear, stellate, longitudinal, 
transverse, and spiral. 

What diseases attack the antrum maxillae (Highmore)? 

Hydrops, empyema, benign tumors (chrondroma, fibroma, 
myxoma, osteoma), and malignant tumors (sarcoma and 
carcinoma) . 

When do the secondary symptoms of syphilis normally 
appear? When do the tertiary symptoms appear? 

The secondary symptoms of syphilis normally appear from 
six to ten weeks after the beginning of the infecting chancre. 

Tertiary symptoms may appear within six months of in- 
fection or not for twenty or thirty years. The time of their 
appearance is largely dependent upon the treatment received 
by the patient. In some cases which have been correctly 
treated they may never make their appearance. 

Give a resume of the constitutional and the local treat= 
ment of inflammation. 

Constitutional treatment: Rest, good hygiene, proper diet, 



SURGERY. 367 

purgatives, emetics, arterial sedatives, diaphoretics, diuretics, 
venesection, hypnotics, narcotics, alteratives, stimulants, and 
tonics. 

Local treatment : Rest, position, heat, cold, counter-irritation, 
local blood-letting (scarifications, leeches, wet cups), moisture, 
stimulants, astringents, antiseptics, alteratives, incisions, sur- 
gical operations, compression, and massage. 

Differentially diagnose chancre, chancroid, and herpes 
progenitalis. 

Chancre has a period of incubation not less than ten days ; 
commences as an erosion, tubercle, papule, or ulcer ; is single, 
or simultaneously multiple; is round, oval, or symmetrically 
irregular; is usually cup-shaped, saucer-shaped, or elevated; 
has a smooth shining red or glazed surface, and may be cov- 
ered by a diphtheritic membrane or scab ; has a scanty, serous 
secretion which is practically never auto-inoculable ; is almost 
always indurated (cartilaginous or parchment-like), the in- 
duration being circumscribed and disappearing under appro- 
priate treatment; is accompanied by little or no pain, and 
often heals spontaneously. 

Chancroid has no period of incubation; commences as a 
pustule or ulcer; is often multiple (frequently by auto- 
inoculation) ; is round, oval, or unsymmetrically irregular 
(with borders described by segments of large circles) ; is 
hollow, excavated, or punched out; has a rough, "worm- 
eaten," whitish-gray surface; has an abundant, muco-puru- 
lent secretion (readily auto-inoculable) ; is only exceptional!}' 
indurated (induration shades off into surrounding tissues) ; 
is painful, and runs an irregular course. 

Herpes progenitalis has no period of incubation, commences 
as a group of vesicles which may coalesce; is multiple, is 
irregular in shape (edges described by segments of small 
circles), is always superficial, has a moderate amount of 
secretion (auto-inoculable with difficulty), has no more in- 
duration than any local ulcer, is painful, and usually heals 
promptly under mild local treatment, (Condensed from 
Keen and AYhite.) 



368 SURGERY. 

How would you diagnose and reduce a backward dislo= 
cation of the forearm? 

The forearm is shortened, semiflexed, and midway between 
pronation and supination. The forearm cannot be flexed 
upon the arm. The olecranon is unduly prominent behind 
the joint, and above it is a depression in which the tendon 
of the triceps may be palpated. The head of the radius may 
be detected as a globular swelling behind the external con- 
dyle. The lower end of the humerus forms a broad promi- 
nence in front of the articulation. This dislocation is dis- 
tinguished from a supracondylord fracture by the following 
points : the olecranon is behind a line connecting the two 
condyles, the condyles do not move with the displaced ole- 
cranon, the distance between the 'acromion and the external 
condyle remains unaltered, and crepitus is absent. 

Reduction: The patient is seated in a chair, the surgeon 
places his foot upon the chair with his knee in the bend of 
the elbow, and presses against the lower end of the humerus, 
at the same time fixing the bones of the forearm by grasping 
them just above the wrist. When this pressure has been 
maintained for some time, the forearm is slowly and forcibly 
flexed upon the arm. By this procedure the interlocking bony 
prominences are disengaged and reduction is effected. 

What are the principal causes of tinnitus aurium? 

Acute otitis media, chronic catarrhal otitis media, chronic 
suppurative otitis media, neurosis of the auditory nerve, 
Meniere's disease, impacted cerumen, anemia, alterations in 
pressure in the labyrinth, obstruction of the Eustachian tube, 
and large doses of quinine or of the salicylates. 

What are the most approved operative procedures in the 
treatment of varicose veins of the lower extremity? 

Excision of the entire vein, excision of a number of sections 
of the vein, excision of a portion of the internal saphenous 
vein (in certain cases), and complete division and double 
ligation of all the superficial veins at the junction of the 
upper and middle thirds of the legs (Scbede's operation). 



SURGERY. 369 

Give the symptoms and treatment of section of the 
median nerve. 

If divided just above the wrist there will be anesthesia over 
the radial side of the palm, over the palmar aspect of the 
thumb, index, middle, and half of the ring fingers, and over 
the dorsal aspect of the terminal phalanges of the same 
fingers. There will be paralysis of the outer group of the 
short muscles of the thumb (abductor, opponens, and outer 
half of flexor brevis pollicis), as a result of which "opposi- 
tion" is impaired, the thumb remaining extended by the side 
of the fingers. The outer lumbricals are also paralyzed, caus- 
ing loss of power of flexion of the index and middle fingers 
at the metacarpo-phalangeal articulation. If divided at the 
bend of the elbow or in the arm, in addition to the previously 
mentioned symptoms, there will be loss of pronation (paralysis 
of flexor carpi radialis), loss of power in the hand-grasp, par- 
ticularly on the radial side, with probable hyperextension of 
the wrist (paralysis of flexor longus pollicis, of the flexor 
sublimis, and of the outer half of the flexor profundus 
digitorum), and paralysis of the palmaris longus. 

Treatment: After all aseptic precautions have been carried 
out, the ends of the nerve are to be sought in the wound and 
approximated by sutures of the finest chromicized cat-gut. 
One or more sutures should pass through the nerve and the 
remainder merely through the sheath. A fine Hagedorn 
needle or a domestic sewing-needle without cutting edges 
should be employed. If difficulty is encountered in bringing 
the ends together, the wrist and elbow joints are flexed to a 
right angle, and subsequently maintained in this position by 
a fixed dressing. 

State the constitutional effects and give the treatment 
of burns. 

Stage of shock or collapse : The surface of the body is cov- 
ered with a cold and clammy sweat, the temperature is sub- 
normal, the pulse is rapid and feeble, and the respirations 
are quick and shallow. The tongue is dry, the patient ex- 
24 



370 SURGERY. 

periences great thirst, vomiting often occurs, and the urine 
and feces may be passed involuntarily. There is congestion 
of the internal viscera, particularly those in relation with 
the portal system. 

Stage of reaction: Symptoms of septic traumatic fever, 
with special symptoms dependent upon inflammatory affec- 
tions of the internal organs (meningitis, peritonitis, enteritis, 
duodenal ulcer). 

Stage of exhaustion or recovery: Symptoms of septicemia 
or pyemia may make their appearance. Death may occur 
from inflammation of the lungs or pleura or from amyloid 
degeneration of the viscera. If repair is healthy, no abnormal 
constitutional condition follows the second stage excepting 
a certain amount of asthenia. 

Local treatment : Superficial burns without vesication sim- 
ply require a dusting powder such as flour or boric acid. 
If vesication is present, the blisters should be opened aseptic- 
ally, and the part enveloped in lint soaked in carron oil 
(equal parts of linseed oil and lime water, with one part of 
oil of eucalyptus in ten of the mixture), or in aqueous solu- 
tions of picric acid (1-200). In deep burns the part should 
be cleansed as thoroughly as possible, and covered by a 
moist antiseptic dressing until the sloughs separate, when the 
resulting granulating surface may be treated on general prin- 
ciples. During the process of cicatrization, great care must 
be exercised lest deformity result from contraction. Such 
deformity may be prevented by the use of splints or weights, 
and particularly by the employment of Thiersch's method of 
skin-grafting. When a limb has been hopelessly charred it is 
best to amputate in healthy tissue at the earliest favorable 
opportunity. 

Constitutional treatment: Promote reaction by external 
heat, hypodermatic injection of strychnine, and some warm, 
stimulating fluid given by the mouth or rectum. Intravenous 
injection of warm saline solution is advisable in some cases. 
If the pain is severe, opium may be administered. During 
the second stage the secretions should be kept active, and 



SURGERY, 371 

the patient placed on a liquid nutritious diet. In the third 
stage, tonics, stimulants, and nutritious easily-digested food 
are indicated. 

Name five of the principal complications of gonorrheal 
urethritis in the male. 

Lymphangitis, bu'bo, prostatitis, cystitis, and epididymitis. 

What are the indications for exsection of the knee= 
joint? 

Tubercular disease, disorganization of joint after pyemia 
or osteo-arthritis, old, neglected cases of infantile paralysis 
where there is a nail-like limb (Wright), certain cases of 
compound fracture (particularly after gunshot wounds), and 
deformity due to fibrous or bony ankylosis in a bad position. 

What is the treatment of depressed fracture of the 
skull? 

All such cases should be trephined under aseptic pre- 
cautions, and the exact amount of intracranial mischief deter- 
mined. The depressed fragment may then be elevated, and 
any pressure upon the brain immediately relieved. 

Give the indications for the removal of the mammary 
gland. 

Carcinoma, sarcoma, diffuse hypertrophy, diffuse septic or 
tubercular disease, and certain cases of interstitial mastitis. 

What is Paget's disease of the nipple? State the spe= 
cial significance of its occurrence. 

Paget's disease of the nipple is said by some to be a form 
of eczema, but according to high authority, it is a destructive 
dermatitis of the papillary layer of the skin. It may be due 
to psorosperms, but this is not definitely settled. The nipple 
affected has an excoriated, bright red surface, which dis- 
charges a yellowish viscid fluid. The excoriation spreads 
until the entire areola is involved and the patient complains 
of burning pain. 

The special significance of the occurrence of the disease is 



372 SURGERY. 

that it is almost always a precursor of cancer, but this is not 
invariably the case. 

What are the indications for incising the membrana 
tympani? 

The evacuation of serum, mucus or pus from the tympanum, 
the relief of anomalies, of tension of the drum membrane, 
and to gain access to the tympanum for the purpose of re- 
moving intratympanic polypi or dividing synechias 

Describe the steps in the treatment of a scalp wound. 

Hemorrhage is to be controlled by pressure or ligation. The 
scalp should be shaved for a distance of several inches from 
the margins of the wound. If the wound is very extensive 
the entire scalp should be shaved. All foreign substances are 
removed from the wound, and it is disinfected with antiseptic 
solutions (bichloride 1-1000). The wound should now be 
sutured with silkworm gut and a moist bichloride dressing 
(1-4000) applied. If the wound subsequently shows signs of 
infection, one or more of the sutures should be immediately 
removed, the wound again disinfected, packed with iodoform 
gauze, and allowed to granulate. After granulation has oc- 
curred it may be closed by secondary sutures. Primary suture 
should be the routine treatment in almost every case. 

How can the danger of ankylosis be averted after injury 
to a joint? 

By surgical cleanliness, rest, and the early employment of 
massage and passive motion. 

What are the symptoms of morbus coxae in its different 
stages? 

First stage : Pain in affected joint and corresponding knee, 
limping or shuffling gait, more or less fixation of the joint 
from muscular rigidity, the knee is slightly flexed and the 
limb is usually abducted. Swelling is most marked in the 
arthritic variety of the disease. Heat and redness are usually 
absent on account of the distance of the articulation from 
the surface. 



SURGERY. 373 

Second stage : Pain is more acute, the child limps decidedly, 
atrophy of the thigh is apparent, and rigidity of the abductors 
is marked. The limb is somewhat flexed, abducted, everted, 
and apparently lengthened. Flattening of the buttocks is 
present, and the sulcus between the nates is no longer vertical, 
but inclined toward the affected side. Full extension and 
abduction are restricted, "starting" pains are present. 

Third stage: Flexion is marked, adduction is present, and 
shortening is observed which is apparent at first, but sub- 
sequently actual. The whole extremity, including the gluteal 
region, is greatly atrophied. If the diseased leg is extended 
so that the knee touches the table, the lumbar curve becomes 
so pronounced that there is frequently room for the arm of 
the surgeon between it and the table. The rima natium is 
inclined away from the affected side, and there is a compen- 
satory double lateral curvature of the spine. Abscesses may 
form and point at the outer side of the thigh below the tro- 
chanter (disease of head of femur), in the pubic region 
(disease of acetabulum), or in the gluteal region (either 
form). If the abscess points above Poupart's ligament, it is 
intrapelvic, if below, extrapelvic. 

What is hydrophobia and how is it treated? 

Hydrophobia is an acute infectious disease resulting from 
the inoculation of a specific virus from an animal suffering 
from rabies. 

Prophylactic treatment: Most important, as no curative 
treatment exists. The wound, if made by a supposedly rabid 
animal, should be freely excised or thoroughly cauterized 
factual cautery is best, caustic potash, fuming nitric acid). 
If this cannot be done at once, constriction should be applied 
upon the proximal side of the wound. The wound resulting 
from excision should be thoroughly disinfected and sutured 
or treated openly, according to the exigencies of the case. 
Prophylactic inoculations with emulsions of the dried spinal 
cords of rabbits infected with hydrophobia (Pasteur treat- 
ment) should be made in all cases where the animal inflicting 



374 SURGERY. 

the bite was rabid, and in those cases in which it can not be 
proven that the animal did not have rabies. The prophy- 
lactic treatment also includes the muzzling of dogs and the 
rigid maintenance of a dog quarantine. 

Palliative treatment: The free use of morphine, chloral 
and chloroform. The patient is kept in a darkened room, 
and all external sources of irritation are removed. Nutritive 
enemata may be given. 

How would you perform tracheotomy? 

The patient is placed in the dorsal position, with the head 
extended, and a cylindric cushion placed beneath the neck. 
An assistant holds the head so that the median line of the 
face will correspond to the median line of the neck. After 
all aseptic precautions have been observed and the various 
landmarks (pomum Adami, cricoid cartilage) located, an 
incision, two and a half inches in length, is made in the median 
line, terminating at the lower border of the thyroid cartilage. 
This incision is made from below upward, and divides the 
skin and superficial fascia. The anterior jugular veins lying 
to either side of the median line should be avoided by cutting 
between them and drawing them aside. The deep cervical 
fascia is now divided, the interval between the pretracheal 
muscles recognized, and the wound deepened by blunt dissec- 
tion. The pretracheal fascia is now divided, and the isthmus 
of the thyroid gland drawn downward. After hemorrhage 
has been checked and the tracheal rings clearly exposed, the 
trachea is steadied by a tenaculum, and two or three rings 
are divided from below upward with a narrow-bladed knife. 
The edges of the tracheal wound are then held apart and the 
tracheal tube inserted. 

What are the symptoms of septic surgical fever? 

There is a sharp rise of temperature 24 or 36 hours after 
the operation or injury. The skin is hot and dry, the pulse 
is rapid, and the tongue is coated. Constipation, anorexia, 
local heat, thirst, restlessness and delirium are present. The 



SURGERY. 375 

urine is scanty and highly colored. The lips of the wound are 
red, swollen and tender. The temperature falls with the 
advent of suppuration. 

What are the indications for trephining in fractures of 
the skull? 

All punctured fractures, all compound depressed fractures, 
all simple depressed fractures, and all cases in which there are 
symptoms of intracranial mischief. 

Mention the different kinds of displacement in fracture. 
In what directions does the line of fracture extend in the 
case of the long bones? 

Varieties of displacement: Angular, transverse, longitud- 
inal and rotary. 

Directions of line of fracture: Transverse, oblique, spiral, 
longitudinal, toothed, Y-shaped, and T-shaped. 

What general principles govern the diagnosis of a tumor? 

The age and sex of the patient, hereditary influence, the 
history of previous trauma, the location, shape, size, con- 
sistency, and rapidity of growth of the tumor, whether the 
tumor is freely movable or fixed to the surrounding tissues, 
whether it is painful, whether it is encapsulated, whether it 
has given rise to metastases, and whether these have occurred 
through the lymphatics or through the blood-vessels, whether 
the neighboring lymphatic glands are involved, and the pres- 
ence or absence of cachexia. 

What is the most common seat of rupture of the quad= 
riceps extensor femoris? Give the symptoms and treat= 
ment. 

At its insertion into the patella. 

Symptoms: Sudden pain in the part, inability to extend 
the leg, and the appearance of ecchymosis several days after 
the injury. A swelling may be felt just above the patella 
(extravasation) or a gap may be observed (retraction of 
muscle) . 



376 SURGERY. 

Treatment: The treatment usually advised is to place the 
part at rest, the leg being extended on the thigh, and the thigh 
being flexed at the hip. This position tends to bring the 
torn ends together. A certain amount of compression is made 
at the site of the injury, and the extremity is kept in the 
position described until union has occurred. If perfect 
asepsis can be obtained, however, primary suture of the mus- 
cle (if healthy) will give better results. 

What are the steps in the ligation of arteries? 

The preparation of the region in which the vessel is situated 
for an aseptic operation, the incision dividing the skin and 
superficial fascia (at an angle of about five degrees to the 
course of the artery), the division of the deep fascia, the 
recognition of muscular or bony landmarks, and the location 
of the vessel by its pulsations, the opening of the sheath, the 
passage of the aneurysm needle, the tying of the ligature, and 
the closure of the wound. 

Give the treatment for talipes calcaneus. 

Division of the extensor tendons. If the tendo Achillis is 
attenuated, a portion of it may be excised and the ends united 
by suture. In other cases the tendon of a healthy peroneus 
longus may be grafted into the tendo Achillis, or the tubercle 
of the os calcis, into which the tendo Achillis is inserted, may 
be sawn off and reattached by a peg to the bone at a lower 
level (Walsham). In the paralytic variety some form of 
apparatus must always be worn. 

What are the causes and treatment of paraphimosis? 

Causes : Gonorrheal balano-posthitis, ulceration from chan- 
cre or chancroid, violent coitus, and edema following upon 
the retraction of a tight prepuce. 

Treatment: The glans should be rendered bloodless by 
digital pressure or by the compression of a finger bandage 
and well anointed with sweet oil. The index and middle 
fingers of each hand are now crossed behind the glans and an 
attempt made to force the glans through the constricted pre- 



SURGERY. 377 

putial orifice by pressing upon it with the thumbs. If the 
edema of the prepuce is very marked, it may be punctured in 
several places to relieve tension. Should this measure fail, 
the preputial orifice (at the bottom of the second groove) is 
to be divided with a sharp-pointed, curved bistoury. Lead 
water and laudanum may then be applied to reduce the in- 
flammatory swelling. 

In what portion of the base of the skull may fractures 
lead to the escape of cerebro=spinaI fluid? 

Cerebro-spinal fluid may escape through the nose in a frac- 
ture of the anterior fossa involving the cribriform plate of 
the ethmoid (if there is a laceration of the mucous membrane 
below the fracture and of the dura and arachnoid above it) ; 
it may escape through the ear in a fracture of the middle 
fossa (if the fracture passes across the internal auditory 
meatus, if the tubular prolongations of the membranes in this 
meatus are torn, if there is a communication between the 
internal ear and the tympanum, and if the membrana tym- 
pani is lacerated) . 

Give the symptoms of sacroiliac disease and mention 
the affections from which it must be differentiated. 

Pain and a sensation of weakness in the lower part of the 
back, which is increased by standing, sneezing, or any move- 
ment which suddenly calls the abdominal muscles into play 
and drags on the ilium. The unfortunate individual feels 
as though his pelvis were coming to pieces. The pain is fre- 
quently referred to the gluteal region or leg (lumbo-sacral 
cord). If the pelvis is not supported, movements of the lower 
extremity are painful. There is apparent lengthening upon 
the affected side, owing to the tilting downwards and forwards 
of the innominate bone. Lateral compression of the pelvis 
causes pain. The region over the joint is often swollen and 
tender. Abscesses may form, and these may point over the 
articulation, upwards into the lumbar region, forwards into 
the groin, or downwards into the pelvis. Sacro-iliac disease 



378 SURGERY. 

must be differentiated from sciatica, hip-joint disease, and 
lumbar spondylitis. 

Give the differential diagnosis between fracture of the 
neck of the humerus and dislocation of the shoulder joint. 

Fracture. Dislocation: 

Elbow readily approximated to side. Elbow cannot be approximated to 

side without causing great pain. 

Elbow can be made to touch chest Elbow cannot be made to touch chest 
with hand of affected extremity with hand of affected extremity 

upon the sound shoulder. upon the sound shoulder. 

Crepitus. No crepitus. 

Preternatural mobility. More or less fixation. 

Shape of shoulder-joint unchanged. Flattening of shoulder-joint, the head 

of the bone being felt in an ab- 
normal position. 

Deformity recurs after reduction. Deformity does not recur after reduc- 

tion. 

Shortening of the arm. Elongation may be present (sub- 

glenoid), or the arm may be of 
same length as that of opposite 
side. 

What are the indications for thyroidectomy? 

Fibro-adenomatous and cystic goitres, parenchymatous 
goitres which increase in size in spite of palliative treatment, 
and carcinoma and sarcoma of the thyroid gland. 

Describe active congestion, passive congestion. State 
their points of difference. 

Active congestion is an increase in the amount of blood in 
the more or less dilated arteries of a part, with an increase in 
the velocity of the blood stream. 

Passive congestion is an increase in the amount of blood in 
the more or less dilated veins and capillaries of a part, with a 
diminished velocity of the blood stream. 

In active congestion the part is reddened, not perceptibly 
enlarged, and the velocity of the blood current, the tempera- 
ture and the functional activity of the part are increased. 

In passive congestion the part is bluish, greatly swollen, 



SURGERY. 379 

and the velocity of the blood current, the temperature and 
the functional activity of the part are diminished. 

What is the usual site of a vulvovaginal abscess? Give 
the symptoms and treatment. 

In the glands of Bartholin at either side of the entrance of 
the vagina. 

Symptoms : Heat, redness, and tenderness, together with a 
peculiar pyriform swelling. In the early stages this swelling 
is best detected by introducing the finger in the vagina and 
pressing outward against the pubic ramus. 

Treatment: Incision and drainage. The wound should be 
irrigated, packed with iodoform gauze, and made to heal up 
from the bottom. The principles of antisepsis obtain here as 
elsewhere. 

How would you operate for the radical cure of complete 
fistula in ano? 

The bowels should be completely evacuated by a suitable 
purgative, and also by an enema, about an hour before the 
operation. The patient is etherized, placed in the lithotomy 
position, and the perineal and anal regions shaved and prop- 
erly cleansed. The external sphincter is forcibly stretched 
by the thumbs in the rectum, and a grooved director is then 
passed into the external orifice of the fistula, through the 
fistulous tract, and brought out through the internal orifice. 
A curved bistoury is now introduced along the grooved 
director, and all the overlying tissues are divided. All 
pockets and tributary branches of the fistula must be opened 
up and curetted. All undermined tissue and unhealthy tags 
of skin should be removed. Hemorrhage should be checked, 
the cavity carefully packed with iodoform gauze, and com- 
pression made over the anal region by a thick pad of sterile 
gauze and a T-binder. 

What affections occur on the female external genitalia? 

Vulvitis, vulvovaginal abscess, vulvovaginal cyst, hema- 
toma of vulva, pruritus vulvae, hypertrophy of the clitoris or 



380 SURGERY. 

of the nymphae, urethral caruncle, noma pudendi, chancre, 
chancroid, syphilitic ulcerations, venereal warts, papilloma, 
myxoma, and epithelioma. A labial hernia or a hydrocele of 
the round ligament may make its appearance in this situa- 
tion. 

What is the cause of the impulse felt in a scrotal hernia 
on coughing? When is this impulse absent in such a her= 
nia, and in what other condition resembling hernia may it 
be present? 

In a scrotal hernia a portion of the abdominal cavity is, so 
to speak, within the scrotum, and any increase in the intra- 
abdominal pressure will, of course, be transmitted to the 
hernial sac. 

This impulse is absent when strangulation is present. 

An impulse on coughing may be present in a congenital 
hydrocele. 

Differentiate between true and false sacculated aneu- 
rysm. 

The sac of a true sacculated aneurysm contains all of the 
coats of the blood-vessels. In a false sacculated aneurysm 
some of the coats of the blood-vessel are absent. 

Describe the signs of each variety of fistula in ano. 

Complete fistula: There is an external opening in the skin 
and an internal opening in the bowel. 

Incomplete external fistula: There is an external opening, 
but no internal opening. 

Incomplete internal fistula: There is an internal opening, 
but no external opening. The internal opening may be dis- 
covered by direct inspection through a speculum and some- 
times by palpation. This fistula is often associated with 
undermining of the mucous membrane or with stenosis of the 
bowel. Signs of inflammation may be present and pus may 
be discharged from the rectum. 



SURGERY. 381 

Describe the several varieties of clubfoot. 

Talipes equinus. The heel is drawn up and the patient 
walks upon his toes. 

Talipes calcaneus. The toes are raised from the ground 
and the patient walks upon his heel. 

Talipes varus. The anterior half of the foot is adducted, 
the inner side of the foot is raised, and the patient walks upon 
the outer side. 

Talipes valgus. The anterior half of the foot is abducted 
and everted, the patient resting upon the inner side of the 
foot. Various combinations of these forms are indicated as 
follows: Talipes equino- varus, talipes equino-valgus, talipes 
calcaneo-varus, and talipes calcaneo-valgus. 

Name the most common varieties of fistula. 

Fistula in ano (complete, blind internal, blind external), 
vesico-vaginal, urethro-vaginal, recto-vaginal, urinary, sali- 
vary, biliary, and intestinal. 

What is lupus? 

Lupus vulgaris is a chronic inflammatory disease of the 
skin and mucous membranes due to the tubercle bacillus, and 
characterized by the formation of nodules of granulation tis- 
sue. These nodules usually ulcerate (lupus exedens), but 
such is not always the case (lupus non-exedens) . 

What are the indications for enucleation of the globe? 

Malignant disease, either primary or extending from adja- 
cent tissues, rupture and collapse of eye-ball, a large irregular 
foreign body in the eye not capable of being successfully 
removed, a large wound in the dangerous region in which 
little hope of obtaining useful sight remains, a small wound 
in the dangerous region with commencing irido-cyclitis, a small 
foreign body not removable by the electro-magnet and causing 
inflammation and shrinking, a wound in the dangerous region 
complicated with traumatic cataract, a corneal wound in 
which severe iritis and panophthalmitis develop in spite of 



382 SURGERY. 

treatment, and any case in which sympathetic ophthalmia is 
threatened. (Modified from Jacobson.) 

Give the symptoms, diagnosis, and treatment of phle= 
bitis. 

Symptoms : The vessel affected becomes swollen, hard, and 
painful. Localized enlargements corresponding to the posi- 
tion of the valves are observed. The overlying tissues are 
dusky and congested, and there may be some edema in the 
area drained by the vein. The part is hot to the touch and 
the patient usually has fever. If suppuration occurs the 
symptoms are those of a localized abscess. 

Diagnosis: In lymphangitis the redness is brighter and 
more localized, enlarged and painful glands are present, there 
is no hard cord-like vein, and the swelling is much less marked. 
In erysipelas the redness is characterized by an abrupt raised 
margin, and gastric disturbances are frequently present. 

Treatment: Absolute rest in bed, with elevation of the 
affected extremity to promote the return of venous blood. 
The affected area is covered with a mixture of equal parts of 
extract of belladonna and glycerine, and the limb is swathed 
in a thick layer of cotton and lightly bandaged to a splint. 
The diet should be nutritious and non-stimulating. When 
the inflammatory symptoms have subsided, and the clot has 
had time to become organized or absorbed, massage should be 
practiced to get rid of the edema and inflammatory thicken- 
ing. If an abscess forms it should be opened antiseptically. 

In septic phlebitis, if seen early, the vein should be ex- 
posed, ligated, the whole of the infective clot turned out, the 
vessel swabbed out with pure carbolic acid or bichloride solu- 
tion (1-500), and stuffed with antiseptic gauze. If the 
deeper veins are infected and this treatment is impossible, 
amputation may be demanded, provided that general infec- 
tion has not taken place. 

Give the causes, symptoms, and treatment of acute 
vaginitis. 

Causes : The presence of irritating foreign bodies, the use 



SURGERY. 383 

of irritating injections, the contact of irritating secretions, 
the irritation of excessive coition, and infection with gonor- 
rhea. 

Symptoms : Local heat, pain, and muco-purulent discharge. 
Inspection shows congestion and sometimes excoriations of 
the vaginal mucous membrane. 

Treatment : Rest in bed, saline cathartics, and frequent hot 
hip-baths. The vagina should be copiously douched twice 
daily with borax (one dram to a quart of water) or with 
liquor plumbi subacetatis (half a fluid-ounce to a quart of 
water). As soon as the acute symptoms have subsided the 
walls of the vagina should be separated by a fold of lint 
soaked in oxide of zinc cream. This lint should be carried 
well up into the posterior fornix, allowed to protrude at the 
vulva, and changed every 24 hours. After the disease has 
subsided the parts should still be douched occasionally to 
prevent recurrence. 

In gonorrheal vaginitis the vagina should be washed out 
every two or three hours, first with a pint or two of an alka- 
line solution, then with a pint of plain water, and then with 
a pint of a medicated solution (acetate of lead, acetate of 
zinc, sulphate of zinc, protargol, alum, tannin). 

Define homologous tumor, heterologous tumor. 

A homologous tumor is a tumor consisting of tissue iden- 
tical with that of the part in which it grows. 

A heterologous tumor is a tumor consisting of a different 
tissue from that of the part in which it grows. (These tumors 
are more properly called heterotopic tumors.) 

How are dislocations distinguished from fractures? 

Dislocations are characterized by more or less immobility, 
by the absence of crepitus, and by the fact that the deformity 
does not usually recur after reduction. 

Fractures are characterized by preternatural mobility, by 
the presence of crepitus, and by the fact that the deformity 
usually recurs after reduction. 



384 SURGERY. 

What is milium? Give the treatment. 

Milium is an affection characterized by the appearance of 
small, pearly, non-inflammatory elevations, which result from 
the accumulation of inspissated sebum in ducts, the outlets of 
which have been occluded. 

Treatment: The lesion should be excised, the contents ex- 
pressed, and the same remedies employed as in seborrhea 
(improvement of general health, relief of constipation, and 
the application of ointments of sulphur, mercury, tar, car- 
bolic acid, or resorcin). 

Describe an operation for circumcision. 

After all aseptic precautions have been carried out, the 
prepuce is drawn forward and grasped by a clamp placed 
just in front of the glans. The portion of the prepuce in 
front of the clamp is then cut off with a sharp bistoury and 
the clamp removed. It will be observed that the skin has been 
removed, but that the mucous surface of the prepuce still 
covers the glans. One blade of a pair of scissors is now intro- 
duced into the perputial orifice and the mucous layer divided 
down to its attachment to the corona. All adhesions between 
the prepuce and glans must be thoroughly broken up and the 
smegma removed. The entire mucous surface of the pre- 
puce is to be trimmed away to within an eighth of an inch of 
its attachment to the corona. Special attention should be 
given to the removal of sufficient tissue from the under side 
of the penis in order to avoid an unsightly projection in the 
neighborhood of the frenum. Hemorrhage should now be 
controlled, the edges of the wound adjusted by a few fine 
catgut sutures, and the line of incision covered by some non- 
irritating antiseptic dressing. 

Give the local treatment of venereal bubo. 

Syphilitic bubo requires no local treatment. 

Gonorrheal bubo may sometimes be aborted by the use of 
pressure and iodine. If the gland suppurates it should be 
incised under antiseptic precautions, curetted, and treated 



SURGERY. 385 

like any abscess. If the suppuration is within the gland and 
limited by the capsule the entire mass should be dissected out 
and the wound closed by primary suture. The latter treat- 
ment is the best method of dealing with suppurating buboes, 
provided that it is adopted at the proper time. 

Give the palliative and the remedial treatment of hydro= 
cele. 

Palliative treatment: Tapping, the use of the suspensory, 
and evaporating lotions (when inflammation of the testicle 
is present) . 

Remedial treatment: Tapping and injection should never 
"be employed. The open method of treatment is now gener- 
ally adopted. One of two methods may be pursued: 1. The 
cavity of the tunica vaginalis may be opened and the tunica 
stitched to the skin. The cavity is drained, washed out daily, 
and the drainage tube gradually shortened. Instead of a 
tube, the cavity may be packed with iodoform gauze. 2. 
The parietal layer of the tunica vaginalis may be excised. 

Give the differential diagnosis of congenital talipes 
equino=varus and paralytic talipes equino=varus. 

In congenital talipes equino-varus the affection exists from 
birth, it is usually bilateral, the circulation is good, there is 
but little wasting of the muscles, the electric reactions are not 
much impaired, the growth of bone is much as usual, and 
furrows are present in the sole. 

In paralytic talipes equino-varus the affection is not de- 
veloped until the second or third year (ushered in by convul- 
sions and fever) , it is more frequently unilateral, the circula- 
tion is feeble, the muscles show extreme wasting, electrical 
reactions are almost entirely absent in the paralyzed muscles, 
the growth of the bones is considerably diminished, and there 
are no furrows in the sole (after Tubby). 

Describe an approved method for the removal of im= 
pacted cerumen. 

The external auditory meatus is to be syringed with warm 
25 



386 SURGERY. 

water (105° F.), to which some bicarbonate of soda has been 
added, and the syringing continued until the canal has been 
thoroughly cleansed. The soda solution is then to be washed 
out with sterile water, the ear wiped dry, and a cotton plug 
worn until bedtime. If the mass should prove obdurate, a 
little warm sweet oil may be dropped into the meatus severaL 
times during the succeeding 24 hours, and the attempt re- 
newed upon the following day. 

Define malignant pustule and give treatment. 

Malignant pustule or anthrax carbuncle is a local lesion 
produced by infection with the bacillus anthracis. It differs 
from ordinary carbuncle in the following respects : Presence 
of a central depressed blackish slough, absence of localized 
pain, absence of suppuration (unless mixed infection is pres- 
ent), and the constitutional symptoms are more marked. 

Treatment: Complete excision at the earliest possible mo- 
ment. The incisions should be carried wide of the disease, 
and the resulting wound should be carefully swabbed over 
with pure carbolic acid or with a solution of zinc chloride 
(1:8). The constitutional treatment should be of a support- 
ing character. 

What are the parietal effects of a severe blow upon the 
abdomen? 

Swelling, discoloration, tenderness, and pain. If a vessel 
of considerable size is lacerated a large extravasation of blood 
will take place, which may descend into the scrotum. Rup- 
ture of one of the muscles of the abdominal wall may occur, 
and this is most frequently observed in the rectus. As far 
as the abdominal parietes are concerned, contusions may re- 
sult in localized peritonitis, abscess, or in ventral hernia. 

Describe the symptoms of fracture of the base of the 
skull in the middle fossa. 

Hemorrhage from the external auditory meatus, or from 
the nose. The blood may be swallowed and subsequently 
vomited. Cerebro-spinal fluid may be discharged from the 



SURGERY. 387 

external auditory meatus, and, when present, is one of the 
most characteristic signs of fracture in this situation. If 
the facial and auditory nerves are injured as they lie in the 
external auditory meatus, there will be signs of paralysis of 
the muscles of expression and deafness upon the affected side. 
In addition to these local signs, symptoms of concussion, of 
compression, or of laceration of the brain may be present. 

What general methods obtain in plastic operations? 

Displacement: Stretching or sliding of tissues. 1. Simple 
approximation after freshening the edges; 2. Sliding into 
position after the transference of tension to adjoining 
localities. 

Interpolation: The tissue is taken from adjacent regions,, 
from a limb, or from another person. 1. Transferring a nap 
with a pedicle; 2. Transplanting without a pedicle (includ- 
ing skin-grafting) . 

Retrenchment : The removal of redundant material causing 
cicatricial contraction. (Abbreviated from Keen and White.) 

What is the treatment of diphtheritic stenosis of the 
larynx? 

Intubation or tracheotomy. The usual treatment of diph- 
theria should also be instituted or continued (injection of 
diphtheria antitoxin, administration of whiskey, hypoder- 
matic injections of strychnine, absolute rest in bed, nutritious 
fluid diet) . If tracheotomy has been performed the temper- 
ature of the room should be maintained at 80° F., and the 
air kept moist with steam. 

Describe a compound fracture. 

A compound fracture is one in which the seat of fracture 
communicates with the external air. Such a fracture may 
be compound through the skin or through the mucous mem- 
brane. These fractures are also called open fractures. 

Give the etiology, varieties, and symptoms of erysipelas. 

Etiology : Infection with the streptococcus erysipelatis. 



388 SURGERY. 

Varieties: Cutaneous, cellulo-cutaneous (phlegmonous), 
and cellular (cellulitis). 

Symptoms: Cutaneous erysipelas is usually ushered in by 
a chill and more or less gastric disturbance. Within 24 hours 
a rash appears in the neighborhood of the wound. There is 
increased tension in the part and a sensation of itching. The 
rash is yellowish-red in color, disappearing upon pressure, 
and has a characteristic elevated border. The area affected 
is well denned, and the margins usually present an irregular 
zigzag outline. When the inflammation reaches its height 
the glazed area is covered with vesicles or bullae filled with a 
clear fluid, which soon becomes turbid. The rash advances 
more or less rapidly with a continuous margin (remaining 
in one situation for about four days), and as it extends to 
new areas it fades in the region first involved and undergoes 
branny desquamation. The neighboring lymphatic glands 
are usually enlarged and painful. Fever is present as long 
as the rash persists. In severe cases the fever is at first 
sthenic, the pulse full, and the delirium noisy and active, but 
the pulse subsequently becomes quick and weak, and there is 
low muttering delirium and great prostration. 

What is shock, and how should it be treated? 

Shock is the immediate constitutional effect of an injury. 

Treatment: In mild cases very little is needed except rest 
in the recumbent position and the exhibition of some pungent 
aromatic to the nostrils. In more severe cases the patient 
must be put absolutely at rest, surrounded by blankets and 
hot water bottles, and all external sources of irritation re- 
moved. Over-stimulation should be avoided, and in many 
cases a cup of hot beef tea may do as much good as a stronger 
stimulant. If the patient appears to be in imminent danger, 
however, more active measures must be adopted. The head 
should be kept low and surrounded with flannel cloths wrung 
out of hot water and frequently renewed. The extremities 
should be wrapped in blankets and external heat applied, 
care being taken not to burn the patient. Ammonia should 



SURGERY. 389 

be exhibited to the nostrils and small quantities of brandy- 
given by the mouth. If the patient cannot swallow, the 
brandy may be diluted and given by the rectum. The rectal 
injection of two or three pints of warm normal saline solution 
(100° F.) is highly recommended. Ether, digitalis, atropine, 
or strychnine may be given subcutaneously, the latter drugs 
being particularly valuable. If the shock is combined with 
loss of blood, a pint of sterile normal saline solution should 
be injected beneath the skin or into a vein. If a mangled 
limb seems to act as a source of depression it may be proper, 
under certain circumstances, to amputate at once. 

What are the symptoms and treatment of a sprain? 

Symptoms : The patient immediately experiences severe 
sickening pain. Swelling soon makes its appearance, due at 
first to extravasation of blood and subsequently to the effu- 
sion of inflammatory products. The patient is unable to bear 
any weight upon the injured extremity, and motions of the 
joint are attended by exacerbations of the pain. 

Treatment: Early and systematic massage is invaluable in 
these injuries. Ten or twenty minutes is usually enough for 
the first treatment, and the period can be lengthened upon 
the following days. During the intervals between the mas- 
sage of the part, it should be kept at rest upon a well-padded 
splint and moderate compression applied. The immediate 
application of cold, followed by heat, is of great advantage 
in some cases. If the sprain is in the ankle or wrist, the 
patient should be encouraged to move his toes or fingers while 
the massage is being performed. The old treatment con- 
sisted in keeping the part at rest until all pain and swelling 
had disappeared, and then employing massage and passive 
motion. 

How and in what part of the inferior maxillary bone is 
fracture most liable to occur, and what is the treatment? 

The inferior maxillary bone is usually fractured by direct 
violence. 



390 SURGERY. 

The most frequent site of fracture is at a point just ante- 
rior to the mental foramen. 

Treatment: Reduction of the displacement, the application 
of a Barton 'bandage and the maintenance of the oral cavity 
in as aseptic a condition as possible. In some cases a leather 
or pasteboard splint may be applied over the point of the 
chin. If there is a great displacement a Hammond splint 
may be placed about the teeth or, if these are defective, 
Kingsley's apparatus may be employed. Some few cases may 
require wiring of the fragments. The parts are to be kept 
at rest for about three weeks, the patient being restricted to 
a fluid diet. 

Describe enucleation of the eye=ball. 

Bonnet's method: All aseptic precautions have been car- 
ried out, the conjunctiva near the cornea is grasped by for- 
ceps and divided with scissors entirely around and close to 
the corneal margin. The conjunctiva is loosened up from 
the eye-ball and the dissection carried well back in every 
direction. The recti muscles are now caught up separately 
by a strabismus hook and their tendons divided close to the 
ball. After the orbital tissues have been well dissected away 
from the ball the enucleation scissors are passed back in the 
orbit until they touch the optic nerve, when their blades are 
opened and the nerve divided as far back as possible. The 
oblique muscles and other remaining tissues are now quickly 
severed, the hemorrhage is checked by hot water or torsion, 
and the orbit flooded with a hot bichloride solution (1:5000). 

A drainage tube is then inserted into the cavity and an 
antiseptic dressing applied. 

How is resection of the spinal accessory nerve effected? 
What are the reasons for this operation? 

After all aseptic precautions have been observed, an inci- 
sion is made along the anterior border of the sterno-mastoid 
muscle, extending from the mastoid process to the cornu of 
the hyoid bone and avoiding the external jugular vein. This 



SURGERY. 391 

incision divides skin, superficial fascia, platysma, a branch 
of the auricularis magnus, and the deep fascia. The sterno- 
mastoid is now drawn outward, and the nerve (with its accom- 
panying sterno -mastoid artery) can be felt just below the 
transverse process of the atlas. The nerve emerges from 
beneath the posterior belly of the digastric and lies upon the 
levator anguli scapulae, beneath the prevertebral fascia. It 
enters the deep surface of the sterno-mastoid muscle midway 
between its two borders and one inch below the tip of the 
mastoid process. A portion of the nerve is now excised, the 
external wound sutured, and an aseptic dressing applied. 

The spinal accessory nerve is excised for spasmodic torti- 
collis of central origin. 

What are the methods of reduction in sub=coracoid dis- 
location of the humerus? 

1. Reduction by manipulation (Kocher's, Smith's). 

2. Extension and counter-extension. 

3. Traction in an outward and upward direction. 

How would you arrest epistaxis? 

If position, rest, cold, hot water, pressure, and spraying 
with peroxide or with a 5 per cent, solution of antipyrine 
(with 2 per cent, cocaine) are inefficient, more active meas- 
ures must be adopted. If the bleeding point can be seen it 
should be cauterized (electricity, chromic acid). When other 
means 'fail the anterior nares should be packed with a strip 
of sterile gauze, the initial extremity of which is carried well 
back toward the naso-pharynx. In rare cases it may be 
necessary to plug the posterior nares by means of Bellocq's 
cannula or a soft rubber catheter. Plugs of gauze should 
never be let in the nose unchanged for more than 24 hours. 

Differentiate between the following forms of inflam- 
mation: Serous, sero=fibrinous, serohemorrhagic. 

In serous inflammation there is a copious exudation of fluid 
with comparatively little cellular matter. 



392 SURGERY. 

In serofibrinous inflammation the exudate contains more 
fibrin, and shows a marked tendency to clot. 

In sero-hemorrhagic inflammation the exudate contains 
large numbers of red blood corpuscles, and is correspondingly 
tinged. 

What is hare=lip? Give the treatment of hare=Iip. 

By hare-lip is meant a congenital fissure of the upper lip 
which may extend for a variable distance through the soft 
tissues. It may be associated with a cleft in the palate. 

Treatment: A straight bistoury should be introduced just 
above the angle of the fissure, and both sides of the cleft pared 
by cutting through the lip in a crescentic manner so as to 
constitute a slight angular projection or prolabium when the 
freshened surfaces are brought into apposition. If the nose 
is much flattened more tissue should be removed from the 
outer than from the inner side, so that when the parts are 
sutured together the nostrils become as nearly symmetrical 
as possible. By paring the edges in a curved or angular 
manner the depth of the lip is increased to allow for subse- 
quent contraction. Two deep silk-worm-gut sutures should 
be introduced, one just above the red margin and one close 
to the nose. The vermilion borders must be accurately ap- 
proximated and the edges of the wound carefully brought 
together with cat-gut sutures. The dressing consists of gauze 
and collodion. The gauze is cut in the shape of a paddle, the 
broad ends being fastened to the cheek. This should be so 
applied as to prevent tension upon the wound. The silk- 
worm-gut sutures are removed upon the fourth day. The 
operation above described is that of Malgaigne. Other opera- 
tions are those of Nelaton, Rose, Mirault, and Konig. Double 
hare-lip may sometimes be treated by operating upon each 
side, as in a unilateral cleft, but if the os incisivum projects 
it must be either removed or replaced. 

Give the etiology of inflammation. 

Predisposing local causes : Defective circulation, loss or 



SURGERY. 393 

impairment of the nervous supply of a part, a previous attack 
of inflammation. 

Predisposing constitutional causes: Anything producing 
an impairment of the general health, such as old age, weak 
action of the heart, an unhealthy condition of the blood, and 
the presence of some constitutional disease. 

Exciting causes: Mechanical irritants, heat, cold, electric 
irritants, toxic irritants (chemical, vegetable, animal), and 
micro-organisms. 

Give the treatment of fracture of the ribs. 

The affected side should be firmly strapped with strips of 
adhesive plaster so as to limit its range of motion. These 
strips (2 inches in width) should extend beyond the median 
line both anteriorly and posteriorly, and are to be applied 
from below upward, each strip overlapping about one-half of 
its predecessor. Each strip should be put on while the chest 
is in a state of forcible expiration. If the patient has ad- 
vanced pulmonary emphysema or chronic bronchitis, strap- 
ping is not advisable, as it adds to the respiratory difficulty, 
and in such a case the patient must be placed in bed or 
propped up, and the fracture left to take care of itself. 
Strapping is also contra-indicated if the broken fragments 
are driven inwards, and if the fracture is in the lower part of 
the chest and the pressure irritates the diaphragm, causing 
hiccough. If there are associated injuries of the thoracic 
viscera, pneumo-thorax, or hemothorax, they must be appro- 
priately treated. 

Mention the varieties of hip=joint dislocation, and de- 
scribe in detail two of these varieties. 

Dorsal, dorsal below the tendon (sciatic), thyroid, and 
pubic. 

Dorsal dislocation : The head of the bone lies upon the dor- 
sum ilii, the trochanter is above Nelaton's line and nearer to 
the anterior superior spine, the ilio-tibial band is relaxed, and 
there is a shortening of two or three inches. A marked 



394 SURGERY. 

hollow is present in the upper part of Scarpa's triangle, and 
the head of the bone cannot be felt in its usual position. The 
thigh is flexed, adducted, and inverted, so that the axis of the 
femur crosses the lower third of the sound thigh and the ball 
of the toe rests upon the opposite instep. The ligamentum 
teres is torn and the capsule is lacerated. The small external 
rotator muscles are usually lacerated, as may also be the 
glutei and the pectineus. The great sciatic nerve may be 
contused or compressed. The ileo-femoral ligament is un- 
injured. 

Dorsal below the tendon (sciatic) : The signs of this dis- 
location are somewhat similar but less marked than in the 
preceding form. There is not so much shortening, since the 
intact obdurator internus tendon prevents the head of the 
bone from traveling upward. The shortening is not more 
than one-half inch or an inch, but it becomes more apparent 
upon flexing the thigh (Allis). The thigh is flexed, ad- 
ducted, and inverted, but the axis of the femur crosses the 
opposite knee and the great toe rests against the ball of the 
great toe of the sound side. The head of the bone is palpated 
with great difficulty owing to the greater thickness of the 
gluteal muscles at this level. Practically the same muscles 
and ligaments are injured as in the dorsal variety. The head 
of the bone is below the tendon of the obturator internus, 
whereas in the former dislocation it is above it. 

Make a differential diagnosis of coma from injury, apo- 
plexy, uremia, opium poisoning, and alcoholic intoxication. 

Concussion: The individual is pale, the pulse is feeble and 
fluttering, the respirations are sighing, the skin is cold and 
clammy, and the urine and feces may be passed involuntarily. 
The pupils vary, sometimes being unequal, but they usually 
react to light. Convulsions occasionally occur. Paralysis is 
not present, and examination of the extremities may give 
some evidence that they have not lost their sense of feeling. 
The patient can usually be aroused by shouting. 

Compression : The unconsciousness is complete and the 



SURGERY. 395 

pupils are dilated and do not respond to light. The skin is 
usually hot and bathed in perspiration. The respirations are 
slow, stertorous, and have a peculiar puffing character, due 
to the paralysis of the muscles of the cheeks. The bladder 
and intestines are usually paralyzed, but the incontinence of 
retention may be present. The pulse is slow, full, and fre- 
quently irregular. The whole body may be paralyzed, but 
hemiplegia is the form most commonly observed. Mono- 
plegias also occur, and are extremely valuable from the 
standpoint of localization. 

Apoplexy: Absolute unconsciousness, stertor, hemiplegia 
or complete paralysis are present. Aid in the diagnosis is 
furnished by the age of the patient and the condition of the 
arteries. The temperature is usually higher in one axilla, 
and conjugate deviation may be observed. The face is 
flushed, the conjunctiva is injected, the pulse is full and slow, 
and the breathing is stertorous. Urine and feces may be 
passed involuntarily, and convulsive seizures are not infre- 
quent. 

Uremia: Paralysis and stertor are absent (unless apoplexy 
co-exists). The legs may be edematous and the urine contains 
albumin and casts. The breath is urinous, arterial tension is 
high, and the aortic second sound is accentuated. 

Opium poisoning: Paralysis is not present, and the pupils 
are pin-point and will not dilate. The odor of laudanum 
may be detected upon the breath. The pulse and respira- 
tions are slow. 

Alcoholic intoxication : Unconsciousness is not complete 
and it is usually possible to arouse the patient. Some aid 
may be furnished by the appearance of the patient, but this 
is frequently misleading. Although the breath may be alco- 
holic, it must be remembered that alcohol may have been 
given in an attempt to revive the individual. The pupils are 
usually contracted but dilate when the patient is aroused. 
The temperature is generally subnormal. 



396 SURGERY. 

Give the symptoms and treatment of hammertoe. 

Symptoms : Hyperextension of the first phalanx, flexion of 
the second to an acute angle, and either flexion or extension of 
the terminal phalanx. The first interphalangeal joint rubs 
against the upper leather of the shoe, and the patient walks 
upon the extremity of the terminal phalanx. Corns are pres- 
ent over the points of pressure, and there is a subcutaneous 
bursa over the head of the first phalanx, causing great pain 
and discomfort. The affection is most frequently observed 
in the second toe. 

Treatment: If the case is seen early, treatment may be 
commenced with the wearing of correctly shaped boots, but 
the affection has usually progressed so far that the excision 
of the first interphalangeal joint or amputation of the toe is 
required. The first operation is the preferable one, since 
amputation is frequently followed by hallux valgus. 

Describe dermoid cysts. In what situations are they 
most commonly found? 

Dermoid cysts are cysts composed of structures which 
naturally belong to the skin or mucous membranes, but which 
occur in situations where these structures are not normally 
found. They may contain all the elements of the skin, such 
as stratified epidermis, a papillary layer, and even subcuta- 
neous connective tissue. Hair follicles and sebaceous glands 
are frequent, and hairs of varying length are almost always 
present. Some forms of dermoids contain teeth, nerve tissue, 
muscle, and bone, and structures resembling intestine are not 
of uncommon occurrence. They have been classified by 
Bland Sutton into sequestration dermoids, tubulo-dermoids, 
and ovarian dermoids. 

Dermoid cysts are found in the ovary, in the testicle, in the 
peritoneum, at the outer angle of the orbit, above the nose, in 
the neck, in the floor of the mouth, in the membranes of the 
brain, and elsewhere. 



SURGERY. 397 

Give the symptoms of shock, and state when the prog- 
nosis is grave. 

Symptoms: The skin is pale, cool, and bathed in perspira- 
tion, the pulse is rapid and weak, the respirations are shallow 
and irregular, and the temperature is subnormal. Nausea 
and vomiting may occur, and the feces and urine may be 
passed involuntarily. The symptoms vary according to the 
severity of the injury, and the patient may suffer from any- 
thing from a sensation of momentary weakness and faintness 
to a most profound muscular relaxation and unconsciousness. 

The prognosis is grave when a vital part is injured, when 
the injury is extensive, entailing a continued source of irrita- 
tion and depression, when a reaction as regards temperature 
is not observed within four hours after the reception of the 
injury, when large quantities of blood have been lost, and in 
old people who are the subjects of degenerative changes. 

How would you proceed surgically to remove the fluid 
in a case of ascites? 

The patient is seated in a chair and the abdomen is encir- 
cled with a flannel binder, the ends of which are split to 
within six inches of the median line. The untorn portion of 
the binder is placed over the front of the abdomen and the 
divided ends are crossed behind and held by assistants so as 
to make continuous pressure upon the abdominal contents. 
A spot is selected in the median line below the umbilicus 
where absolute dulness is obtained upon percussion. After 
all aseptic precautions have been observed, the skin over this 
small area is anesthetized by a drop of carbolic acid or by the 
intradermic injection of Schleich's solution, a small incision 
is made through the skin, and a suitable trochar and cannula 
is inserted. The fluid should be withdrawn slowly, continu- 
ous pressure being made upon the abdominal contents by 
means of the flannel binder. All of the fluid should not be 
withdrawn. After the withdrawal of the cannula the small 
wound should be closed with aseptic gauze and sterile col- 
lodion. 



398 SURGERY. 

Differentially diagnose impacted and non=impacted frac- 
ture of the neck of the femur. 

Impacted Fracture. Non-impacted Fracture. 

Crepitus is absent. Crepitus may be obtained. 

Eversion is less marked and inversion Eversion is present. 

may be present (rare). 

The head of the femur moves under The head of the femur does not move 

the finger when the extremity is under the finger when the extrein- 

rotated. ity is rotated. 

The shortening is not overcome by Shortening is overcome by extension. 

moderate extension (danger!). 

The symptoms of fracture are not so The symptoms of fracture are more 

marked. marked. 

The individual may be able to walk The individual is unable to walk. 

(do not allow her to try,. 

Name and describe the different varieties of fracture. 

Simple (subcutaneous) : No communication with external 
air. 

Compound (open) : Communication with external air. 

Complete : The entire thickness of the bone is involved. 

Incomplete : The entire thickness of the bone is not involved. 

Multiple : The bone is fractured in more than one place and 
the lines of fracture do not communicate. 

Single : The bone is fractured in but one place. 

Comminuted : The bone is fractured into a number of frag- 
ments and the lines of fracture communicate with each other. 

Complicated: In addition to the fracture, a neighboring 
joint is dislocated, the main artery or nerve of the extremity 
is injured, or there is a severe laceration of the soft parts. 

Fissured : A linear split without displacement. 

Stellate : The lines of fracture radiate from a central point. 

Depressed : There is a crushing in of a portion of the bone. 

Impacted : One fragment is driven into the other. 

Apophyseal: A separation of a scale of bone to which a 
ligament or tendon is attached. 

Longitudinal, transverse, oblique, and spiral : The designa- 
tions indicate the directions of the line of fracture. 



SURGERY. 399 

Describe the anatomic varieties of abdominal hernia. 

Oblique, or external inguinal : The hernia in all cases enters 
the inguinal canal through the internal abdominal ring, ex- 
ternal to the deep epigastric artery. This variety is called 
complete if it escapes through the external abdominal ring 
(scrotal hernia in the male, labial in the female) ; it is called 
incomplete (bubonocele) if it remains in the inguinal canal. 

Direct, or internal inguinal: The hernia gains entrance to 
the inguinal canal by passing through Hesselbach's triangle 
(bounded by edge of rectus, deep epigastric artery, and Pou- 
part's ligament). It does not pass through the internal 
abdominal ring, and the neck of the hernia is internal to the 
deep epigastric artery. 

Femoral: The hernia passes out of the abdominal cavity 
through the femoral canal and makes its appearance upon the 
thigh. 

Umbilical: The hernia passes through the umbilical ring. 

Obturator: The hernia passes through the obturator canal 
and may make its appearance upon the thigh. 

Sciatic : The hernia passes out of the pelvis through one of 
the sacro-sciatic foramina (usually through the greater) and 
makes its appearance at the lower border of the gluteus maxi- 
mus. The neck of the hernia is above the great sacro-sciatic 
ligament. 

Perineal : All hernias which protrude through the muscular 
floor of the pelvis toward the perineum are designated as 
perineal hernias. The neck of the hernia is below the great 
sacro-sciatic ligament. They receive special names according 
as to whether the skin, the vagina, or the rectum is pushed 
in advance of the hernial protrusion. 

Inguino-perineal (Coley) : A hernia associated with mal- 
descent of the testis. In these cases the testicle is in the 
perineum and the hernia follows the testicle. 

Diaphragmatic: The hernia protrudes through the dia- 
phragm. Many of these cases are not true hernias, as they 
have no sac of peritoneum. 



400 SURGERY. 

Ventral : The hernia appears at any portion of the anterior 
abdominal wall except the umbilicus. They are subdivided 
into epigastric hernia (in the median line above the navel), 
hernia of the linea alba (below the navel), and lateral ventral 
hernia. 

Lumbar: A hernia making its appearance in the lumbar 
region. It is commonly taught that it passes through Petit 's 
triangle, but no such instance has ever been proved by dis- 
section (Sultan). In some instances it passes through 
Braun's space. 

Internal hernias : 1. Hernia through the foramen of Wins- 
low. 2. Hernia through the duodeno-jejunal recess (retro- 
peritoneal). 3. Hernia through the retro-cecal and ileo-cecal 
recesses (retro-peritoneal). 4. Hernia through the inter- 
sigmoid recess (retro-peritoneal). 5. Retro- vesical hernia. 
The lateral vesico-umbilical fold is so markedly developed 
that a peritoneal pocket is produced at one side. 

Describe the symptoms and give the treatment of hem- 
orrhage from the middle meningeal artery. 

Symptoms: The first symptoms are those of concussion. 
These are followed by a temporary return of consciousness 
(very important) and the gradual onset of coma within 24 
hours, usually without any rise in the temperature. Since 
the blood clot presses upon the motor area, localized twitch- 
ings or paralyses may be present. The paralysis is apt to be 
progressive, commencing in the face and then extending to 
the arm and leg. If the clot gravitates toward the base the 
pupil of the same side will be dilated and immobile ; if on the 
left side aphasia will be present, the pulse will be frequent, 
the respiration slow and stertorous, and the temperature will 
rise to 101° to 103° (or even higher) upon the side opposite 
the clot. 

Treatment: The anterior branch of the middle meningeal 
is the one commonly involved, but the posterior may also be 
the source of the bleeding. After all aseptic precautions 
have been carried out, a semicircular flap is turned down and 



SURGERY. 401 

the skull trephined. The pin of the trephine is placed upon 
.a point one and one-fourth inches behind the external angular 
process at the level of the upper border of the orbit (anterior 
branch). If the clot is not found the trephine should be 
immediately reapplied just below the parietal eminence at 
the same level as the first opening (posterior branch). The 
clot should now be removed, the trephine opening being en- 
larged with rongeur forceps if necessary, and the cavity 
thoroughly irrigated with sterile water. If the artery is still 
bleeding it should be tied by passing a cat-gut ligature through 
the dura and about the artery by means of a Hagedorn needle. 
Drainage should be provided for and the wound closed in the 
ordinary manner. If there is evidence that the clot is gravi- 
tating toward the base, the first trephine opening should be 
made at a point one-half inch lower than that above given. 

Give symptoms and treatment of fracture of the nasal 
bones. 

Symptoms: Crepitus, deformity (depression or lateral dis- 
placement), preternatural mobility, swelling, and ecchymosis. 
Severe epistaxis, surgical emphysema, and cerebral symptoms 
are occasionally encountered. 

Treatment: Reduction at the earliest possible moment in 
order to avoid the persistence of the deformity. It is best 
to give an anesthetic, as these parts are exceedingly sensi- 
tive, and the reduction should be accurate and deliberate. 
The fragment is best returned to its proper position by a 
padded dressing forceps carried well up into the nose and 
assisted by external manipulation. Should there be any 
tendency toward a recurrence of the displacement the nasal 
chamber should be carefully packed with sterile gauze and 
the packing renewed every 24 hours. 

Describe the steps in the operation of stretching the 
facial nerve. 

After all aseptic precautions have been observed, an inci- 
sion is made commencing behind the pinna opposite the ex- 
26 



402 SURGERY. 

ternal auditory meatus and extending downward and forward 
behind the lobule of the ear to the angle of the jaw. This 
incision divides the skin, superficial fascia, superficial layer 
of the deep fascia, and branches of the auricularis magnus 
nerve. The flaps are now dissected from the parotid gland, 
sterno-mastoid muscle, and mastoid process, care being taken 
to avoid the posterior auricular nerve, vein, and artery. The 
internal jugular vein is close to the posterior margin of the 
wound. After the parotid gland has been separated from 
the mastoid process the trunk of the nerve is found lying on 
the styloid process just above the posterior belly of the digas- 
tric muscle. The nerve is stretched by lifting it up with a 
blunt hook. The external incision is sutured and an anti- 
septic dressing applied. 

How would you expose the brachial artery for ligation 
in the middle of the arm? 

After all aseptic precautions have been observed, an inci- 
sion is made along the inner edge of the biceps muscle. The 
line of the artery is from a point just to the inner side of the 
center of the clavicle to midway between the two 'Condyles. 
The incision divides the skin, superficial fascia, twigs of the 
internal cutaneous nerves, and small branches of the superior 
profunda and anterior circumflex arteries. The deep fascia 
is now divided and the inner edge of the biceps recognized. 
The arm should be held at right angles to the body and not 
allowed to rest upon any support, since the triceps muscle 
would displace the biceps and our muscular guide would be 
lost. The biceps is now displaced outwards and the pulsa- 
tions of the artery sought for. The median nerve generally 
lies over the artery in this position of the arm. It should be 
drawn inward and the sheath of the vessel opened. 

Give the treatment of foreign bodies in the trachea. 

The performance of a low tracheotomy, a sufficiently exten- 
sive opening being made in the trachea. If the foreign body 
cannot be removed at the time of the operation, by means of 



SURGERY. 403 

delicate forceps, coin-catcher, wire loop, or hooked probe, the 
edges of the tracheal wound should be sutured to the cuta- 
neous incision, and the foreign body, if movable, will usually 
be spontaneously expelled. If the foreign body is not ex- 
pelled within a day or two, the trachea and bronchi should 
be examined with a long probe. This excites violent cough- 
ing, which may dislodge the foreign body. The patient may 
be also inverted and simultaneously struck upon the back at 
the level of the tracheal bifurcation (fourth dorsal vertebra). 

Describe a method of differentiating between (a) the 
urethra, (b) the bladder, and (c) the kidneys as the sources 
of pus in the urine. 

Urethra : It is usually stated that if the urine is passed into 
two beakers, the first quantity will be turbid and the second 
one clear. If the pus originates in the posterior urethra, 
however, it regurgitates into the bladder and both specimens, 
will be turbid. (Finger.) The urine will usually be acid, 
the pus will be in small quantities, and there will be signs of 
the local inflammation. 

Bladder : The freshly drawn urine will be alkaline, and may 
contain crystals of triple phosphate. The urine is increased 
in amount, and the last portions passed contain ropy, thick 
mucus. It may be possible to identify bladder cells in the 
sediment, and the pus corpuscles are said to be better formed 
than when they originate in the kidney. 

Kidney: In pyonephrosis the discharge of pus may be 
intermittent, clear specimens being obtained for days or even 
weeks. In calculous and tubercular pyelitis the pyuria is 
usually continuous. The pus is more intimately mixed with 
the urine than when it originates in the bladder or urethra, 
and the urine is acid in reaction. 

In all three instances the history of the case will be of 
value. 

Describe in detail the condition known as talipes equino- 
varus. 

In the affection known as talipes equino-varus the heel is 



404 SURGERY. 

drawn up and the anterior half of the foot is adducted and 
drawn inwards. The inner border of the sole is concave, and 
traversed by a sulcus corresponding to the position of the 
mid-tarsal joint; the outer border is convex, and this con- 
vexity is usually covered by a bursa. The sole of the foot is 
arched from secondary contraction of the plantar fascia and 
some of the plantar muscles (particularly the abductor hal- 
lucis), and its center may be marked by a longitudinal crease 
due to a folding over of the outer metatarsal bones. The 
individual walks upon the outer border of the foot, and, in 
neglected cases, even upon the dorsal aspect of the cuboid 
bone. 

In acquired cases the extensor and peroneal muscles are 
paralyzed, and the tibialis anticus, tibialis posticus, flexor 
longus digitorum, and the tendo-Achillis are secondarily 
shortened. 

The astragalus is displaced forwards and outwards, and is 
the most deformed of all the tarsal bones. The neck of the 
bone is elongated, and the angle between the neck and the 
body, instead of being 35 degrees (child) or 10 degrees 
(adult), is increased to 50 degrees or even more. The sca- 
phoid is pushed to the inner side of the astragalus, the tuber- 
osity approaching or even touching the internal malleolus. 
The ligaments on the inner side of the foot are contracted 
(anterior portion of deltoid, inferior calcaneo-scaphoid, long 
and short plantar ligaments). 

What means has the surgeon at his command for the 
separation of tissues? 

Knife (scalpel, bistoury, tenotome), scissors, thermo-cau- 
tery, ecraseur, snare, elastic constriction, saw, trephine, 
chisel, osteotome, and the osteoclast. 

Describe talipes equinus and give its treatment. 

In the affection known as talipes equinus the heel is drawn 
up so that the patient walks upon the metatarso-phalangeal 
joints and the toes. The degree of deformity ranges from 



SURGERY. 405 

those cases in which there is simply a slight elevation of the 
heel to those in which the foot is almost vertical, and the 
plantar muscles and fascia so contracted that the patient 
walks upon the heads of the metatarsal bones, the toes being 
in a position of hyperextension (or even of hyperflexion) . 

Treatment : The milder cases may be treated by means of 
Sayre's apparatus, but subcutaneous division of the tendo- 
Achillis is usually required. The foot is subsequently placed 
in its normal position and put in plaster of Paris. The foot 
is kept in plaster for three months, and a mechanical support 
(rendering extension beyond a right angle impossible) should 
be worn for a year. In severe cases it may be necessary to 
divide the plantar fascia and elongate the tendo-Achillis by 
splicing. In the most obstinate cases some surgeons excise 
the astragalus. 

What are the symptoms of a foreign body in the stom- 
ach? Give the treatment. 

The symptoms of a foreign body in the stomach are fre- 
quently most obscure. There may be a sensation of weight 
and distress, and if the object is rough and irritating there 
may be local tenderness and vomiting of blood-tinged fluid. 
The X-ray will usually furnish valuable aid. 

Treatment : If the foreign body is small, non-irritating, and 
capable of being passed per rectum, the patient should be 
made to eat large quantities of foods leaving a considerable 
residue. If the foreign body will not pass the pylorus it 
should be removed by gastrotomy. 

What are the causes of acute prostatitis? Describe a 
typical case of acute prostatitis and give the treatment. 

Causes: Urethritis (usually gonorrheal), traumatism, strict- 
ure, retention of decomposing urine, prostatic calculi, and 
cystitis. 

Symptoms: Deep-seated pain, accompanied by a sensation 
of heat and weight in the perineum. The desire to pass water 
is frequent and micturition is painful, particularly at the 



406 SURGERY. 

conclusion of the act. Defecation is painful, and digital 
examination per rectum reveals a hot and exquisitely tender 
swelling of the prostate gland. The perineum is also hot and 
tender. The patient cannot sit comfortably, but will support 
his weight upon one buttock to avoid any pressure upon his 
perineum. If suppuration occurs, as is usually the case, the 
pain becomes more marked and of a throbbing character, the 
perineum becomes red and edematous, retention of urine may 
occur, and the passage of a catheter causes excruciating pain. 
Fever is present, and there may be a marked chill. The 
abscess may discharge through the urethra, rectum, perineum, 
or above Poupart's ligament. 

Treatment : Absolute rest in bed, and a bland, non-irritating 
diet. The bowels should be kept loose to avoid the pressure 
of hardened feces upon the inflamed organ. Hot hip baths 
sometimes cause a marked diminution of the pain. If the 
case is seen early, leeches followed by hot fomentations should 
be applied to the perineum. If the pain is intense, supposi- 
tories of morphin and belladonna should be given. If reten- 
tion is present the urine should be drawn off with a small 
rubber catheter. If suppuration has occurred the passage of 
the catheter will occasionally rupture the abscess, which may 
then evacuate itself through the urethra. If this does not 
occur, and there are evidences of deep-seated suppuration, 
or if the pus does not discharge freely, the patient should be 
etherized and placed in the lithotomy position. The finger 
is now introduced into the rectum and an incision made in 
the median line of the perineum down to the scat of pus for- 
mation. The abscess cavity is then evacuated, irrigated, and 
a drainage tube introduced. 

Give the course, symptoms, and treatment of varicocele. 

Course: The affection appears in early adult life (rarely 
after 35), and is practically always upon the left side, vari- 
cocele of the right side alone being almost unheard of. In 
many cases it persists throughout life without any injury to 



SURGEBY. 407 

the individual, while in some cases it may lead to atrophy of 
the testicle. 

Symptoms: A swelling situated along the spermatic cord 
and feeling like a bunch of earth-worms. The swelling is 
compressible, gives an impulse upon coughing, disappears 
when the patient lies down, and reappears when he stands up. 
even though firm pressure is made over the site of the external 
ring. In most cases the scrotum is relaxed and flabby, and 
there may be a sensation of dragging weight, or even of actual 
pain. The testicle upon the affected side may be smaller or 
flabby, but it is nearly always perfectly healthy. Many indi- 
viduals with this affection worry themselves into a condition 
of mental disquietude out of all proportion to the local dis- 
ease. 

Treatment. Palliative : A well-fitting suspensory bandage. 

Operative: Operative treatment is to be adopted if the 
patient desires to enter the army or navy, if the affection 
causes physicial discomfort despite the wearing of a suspen- 
sory, and if the mental condition of the patient cannot be 
relieved until the varicocele is removed. The operation for 
the cure of varicocele consists of the excision of a section of 
the dilated veins. The incision is to be made in the groin, 
and not in the scrotum, as was formerly practiced. About 
two inches of the cord is drawn up through the incision, the 
vas deferens (feels like a "whip-cord") and its accompany- 
ing vessels are carefully isolated and not included in the 
double ligature (chromicized cat- gut). The ligatures are 
placed at a distance of from one to two inches from each 
other and the intervening bundle of veins is removed. One 
end of each ligature is cut short, and the other ends are tied 
so that the cord is shortened and the testicle elevated. To 
insure accurate apposition of the two stumps it is well to 
insert one or two sutures of fine cat-gut. All hemorrhage 
must be thoroughly arrested to insure the best results. The 
testicle is now drawn down into the scrotum and the cuta- 
neous incision sutured in the customary manner. 



408 SURGERY. 

Describe McBurney's " grid=iron " incision for appen- 
dicitis. What is the advantage of this incision and what 
is the disadvantage? 

After the skin has been carefully disinfected, an oblique 
incision about three inches in length is made, commencing 
one inch above McBurney's line and crossing this line about 
an inch and a half internal to the anterior-superior spine. 
The position of the incision will naturally vary somewhat 
according to the location of the swelling, but it should always 
be made in the direction of the fibres of the external oblique 
muscle. The aponeurosis of the external oblique and a small 
portion of the muscle itself are now divided in the direction 
of the external incision. The fibres of the external oblique 
muscle should be separated (not incised), great care being 
taken that none of the fibres are divided transversely. Re- 
tractors are now placed in the wound and the internal oblique 
and the transversalis muscles are similarly split in the direc- 
tion of their fibres. The transversalis fascia and peritoneum 
are then divided in the usual manner. 

The advantage of the incision is that the abdominal wall is 
not weakened as much as if the muscular fibres were cut 
across, and therefore there is consequently less tendency to 
subsequent ventral hernia. 

The disadvantage of the incision is that the amount of 
room to work in is somewhat lessened, and the performance 
of the operation consequently rendered more difficult. 

What is the difference between congestion and inflam- 
mation? 

Arterial congestion is an excess of blood in the more or less 
dilated arteries of a part, the velocity of the blood-current 
being increased. The part is reddened, the temperature is 
increased, swelling is scarcely appreciable, pain is not present, 
except that the patient may complain of a throbbing sensa- 
tion, and the function and nutrition of the part are increased. 
If the congestion continues the part becomes either hyper- 
trophied or inflamed. 



SURGERY. 409 

"Inflammation is the succession of changes which occur in 
a living tissue when it is injured, provided that the injury is 
not of such a degree as to at once destroy its structure and 
vitality." (Burdon Sanderson). The part is reddened, the 
temperature is increased, swelling may be considerable, and 
pain is present dependent upon the character of the tissue 
involved and the severity of the inflammation. The function 
of the part is diminished and fever is usually present. 

How would you diagnose and treat a case of fracture of 
both bones of the forearm occurring at the middle third? 

The diagnosis is usually apparent at a glance. There will 
be angular deformity, as a rule, crepitus, a new point of 
motion (preternatural mobility), pain, and subsequently 
swelling and ecchymosis. The power of supination and pro- 
nation is entirely lost. In those cases in which the diagnosis 
might be doubtful the X-ray will reveal the nature of the 
lesion. 

Treatment: Reduction by extension and counter-extension 
combined with manipulation at the site of the fracture. 
After the deformity has been reduced the forearm should be 
kept flexed at a right angle to the arm and in a position 
midway between pronation and supination (thumb up!) 
Two splints should be applied, a palmar extending from the 
bend of the elbow to below the wrist. The splints should be 
firmly and evenly padded, and must be broad enough to pre- 
vent circular constriction of the forearm. A primary roller 
should never be applied, and an interosseous pad is not to be 
employed. Union is usually complete in four or five weeks. 

Define amputation in the continuity and amputation in 
the contiguity of a limb. 

By amputation in the continuity of a limb is meant an 
amputation through the bone or bones of the extremity. 

By an amputation in the contiguity of a limb is meant an 
amputation through any of the joints of the extremity. 



410 SURGERY. 

Define the following terms: (a) Bursitis; (b) bunion; 
(c) paronychia. Give the treatment for each disease. 

By bursitis is meant the inflammation of a bursa. 

By a bunion is meant an inflammation of one of the bursas 
about the foot, usually over the metatarso-phalangeal joint 
of the great toe. 

By paronychia or felon is meant an inflammation of a fin- 
ger. It may be subcuticular, subcutaneous, thecal (suppur- 
ative teno-synovitis), or subperiosteal (bone felon). 

Simple acute bursitis is treated by keeping the part at rest 
and the application of fomentations. If the effusion per- 
sists it may be aspirated or the entire cavity may be excised. 
Suppurative bursitis should be treated by early and free 
incision and the subsequent maintenance* of effective drain- 
age. Chronic bursitis may be met by rest and counter-irri- 
tation; if these measures fail the bursa should be dissected 
out. Special care must be exercised in dealing with bursae 
which communicate with a joint. In tuberculous bursitis 
the part should be freely incised, the tubercular tissue 
scraped away, and the cavity packed with iodoform gauze. 

The treatment of bunion is that of acute or of suppurative 
bursitis. If the bone is diseased it must be removed, and any 
malposition of the toe corrected during the period of conva- 
lescence. In some cases the underlying joint must be re- 
sected. 

All varieties of paronychia are best treated by a free and 
early incision extending well into the inflamed area. In the 
subcuticular and subcutaneous varieties care must be taken 
not to incise the sheaths of the tendons and thus give rise to 
additional infection. In the subperiosteal whitlow, the inci- 
sion should go down to the bone, and cannot be made too early. 

Describe the various steps in the operation of inguinal 
colostomy. 

After all aseptic precautions have been observed, an inci- 
sion about two inches in length is to be made, one and one- 
half inches above and parallel with the outer portion of 



SURGERY. 411 

Poupart's ligament. This incision should be carried down 
to the peritoneum. All hemorrhage having been checked, 
the parietal peritoneum is to be incised for about two-thirds 
the length of the external wound and accurately stitched to 
the skin. While this step of the operation is being performed 
the intestines should be held out of the way by a sterile gauze 
pad. After the colon has been found it should be drawn out 
of the wound, pulling from above downward, and returning 
the protruding bowel through the lower angle as it is drawn 
out from the upper one. As soon as the colon is almost taut. 
an opening is made in the meso-sigmoid (or descending meso- 
colon, as the case may be) and a glass rod passed through it 
so as to bring a coil of intestine out of the wound, the ends of 
the rod resting upon the skin. The two limbs of the intes- 
tinal coil are fixed by suturing them together beneath the 
glass rod. An aseptic dressing is now applied. Adhesions 
will be sufficiently firm by the third or fifth day. when the 
intestine may be opened by a transverse incision. This latter 
step may be performed without an anesthetic. A few days 
later all of the bowel projecting above the skin may be cut 
away and the bleeding carefully checked. Should it be neces- 
sary to open the bowel immediately, the intestine should be 
accurately sutured to the lips of the cutaneous incision and 
a Paul's tube tied in place. 

Describe an operation for wry=neck. 

Open myotomy of the sterno-cleido-mastoid muscle. All 
aseptic details having been observed, the skin is freely incised 
about a half inch above the clavicle, and the sterno-cleido- 
mastoid muscle is freely divided at the level of the cutaneous 
incision, the external wound is closed, and an aseptic dressing 
is applied. The faulty position of the head is then over- 
corrected and fixed in its new position by a plaster of Paris 
bandage or other suitable contrivance. 

What are the causes of dysphagia? 

1. Pharyngeal : Acute or chronic inflammation, tubercu- 



412 SURGERY. 

losis, syphilis, malignant growths, stricture, paralysis, naso- 
pharyngeal polypi, impaction of foreign 'bodies, and retro- 
pharyngeal abscess or tumor. 

2. Laryngeal : Acute or chronic inflammation, tuberculosis, 
syphilis, or malignant growths. 

3. Esophageal: 'Acute or chronic inflammation, impaction 
of foreign bodies, the presence of diverticula, esophagospasm, 
and simple or malignant stricture. 

4. Extrinsic causes: Aneurysm, goitre, enlarged glands, 
mediastinal growths, pericardial effusion, tumors growing 
from the bodies of the vertebra, and backward dislocation of 
the sternal end of the clavicle (modified from Rose and Car- 
less). 

What are the varieties of arteriovenous aneurysm and 
state their points of difference. 

An arterio-venous aneurysm is either an aneurysmal varix 
or a varicose aneurysm. 

An aneurysmal varix is a direct communication between 
an artery and a vein without the interposition of a sac. 

A varicose aneurysm is an indirect communication between 
an artery and a vein with the interposition of a sac. 

Give the main points of difference between acromegaly, 
ostitis deformans, and leontiasis ossea. 

Acromegaly occurs in young adults (20-30). It affects the 
bones of the hands and feet and those of the face (particu- 
larly the lower jaw and the nasal bones). The cranial bones 
are not affected, with the exception of the lower portion of 
the frontal bones and the margins of the orbits. The bones 
of the hands and feet are broader, but there is no increase in 
their length. Microscopically the osseous structure does not 
differ from that of normal bone. 

Ostitis deformans begins more commonly in men past mid- 
dle life. It affects the long bones of the extremities and the 
bones of the cranium. The facial skeleton shows little 
change. Kyphosis is present. Pain is present in the early 



SURGERY. 413 

stages of the disease, but, unlike other bone pains, it is not 
worse at night. The affected long bones are increased in 
length. The microscope reveals changes similar to those of 
rarefying ostitis. 

Leontiasis ossea begins in early life, and the extremities are 
not affected. Both the facial and the cranial bones are in- 
volved, the bones of the jaws first becoming enlarged. 

Give the treatment for mammary carcinoma. 

The treatment of mammary carcinoma consists of the earli- 
est possible removal of the entire breast, together with the 
axillary and supraclavicular glands. All these structures 
should be removed in one continuous piece, so that no infected 
lymphatic vessel is divided. Advanced cases may require the 
removal of the sternal portion of the pectoralis major and of 
the pectoralis minor, and in such eases the entire mass re- 
moved should also be in one piece. The sharpest knife ob- 
tainable should be used. The first thought in the mind of the 
surgeon should be to remove all of the cancerous tissue, the 
closure of the wound being a consideration of secondary 
importance. Adequate drainage should be provided, and 
skin grafting should be resorted to if sufficient cutaneous 
covering cannot be safely left to close the wound. Those 
cases are to be regarded as inoperable in which the disease is 
no longer local. Palliative operations may be performed for 
the relief of pain in certain well selected cases. 

Describe the various steps in amputation at the wrist by 
a long palmar flap. 

After all aseptic precautions have been observed, the hand 
is supinated, the thumb is abducted, and an incision is made 
commencing at the styloid process of the radius and extend- 
ing over the thenar eminence to the distal transverse palmar 
crease. This incision is continued transversely across the 
palm and then up over the hypothenar eminence to the styloid 
process of the ulna. This flap is now dissected away from 
the bones, and contains all of the structures of the palm ; the 



114 SURGERY. 

flexor tendons and large nerves should be divided at the level 
of the wrist joint and removed. The hand is then placed in 
the pronated position and a slightly curved incision is made 
connecting the two styloid processes, the convexity of the 
incision being directed downward. The extensor tendons 
and the lateral and posterior ligaments of the wrist are 
divided and the hand removed. After all hemorrhage has 
been checked the palmar flap is brought over the ends of the 
bones and held in position by interrupted sutures of silk- 
worm-gut. An aseptic dressing is then applied. 

How does ulceration differ from mortification? 

By ulceration is meant the molecular death of a part; by 
mortification (or gangrene) is meant molar death or the 
death of the part en masse. 

Differentially diagnose phimosis and gonorrhea from 
phimosis and subpreputial chancroid. 

In phimosis and gonorrhea there is no history of a sore on 
the glans or prepuce, the preputial swelling is at first simply 
edematous, the discharge is usually purulent, there is no local- 
ized area of hardness or tenderness, chordee is frequently 
present, the ardor uringe is felt along the entire urethra, 
vesical symptoms are not uncommon, and bubo is very rare. 

In phimosis and subpreputial chancroid there is a history 
of a sore, the preputial swelling is due to plastic exudate 
about the ulcer, the discharge is frequently bloody, a localized 
area of hardness or tenderness is usually present, true chordee 
never occurs, the ardor urinae is experienced only when the 
urine comes in contact with the ulcerated foreskin, vesical 
symptoms are absent in uncomplicated cases, and bubo is 
common. 

Describe Bassini's operation for the radical cure of ob= 
lique inguinal hernia. 

After all aseptic details have been observed, an incision is 
made parallel to and one-half inch above Poupart's ligament. 
This incision extends from above the center of Poupart's lig- 



SURGERY. 415 

ament to the base of the scrotum, and exposes the aponeurosis 
of the external oblique and the external abdominal ring. All 
hemorrhage having been checked, a grooved director is carried 
into the inguinal canal, and the aponeurosis of the external 
oblique is divided to a point well above the internal abdominal 
ring. The upper flap of aponeurosis is freed until the arching 
fibres of the conjoined tendon come into view ; the lower flap 
is drawn down until the shelving edge of Poupart's ligament 
is exposed. The sac is now separated from the cord (the cord 
usually being behind the sac), and this separation is carried 
up to the internal ring. The sac is opened, adhesions prop- 
erly dealt with, omentum ligated in sections, and the intestine 
returned to the abdominal cavity. The sac is then ligated at 
a point high up, just above the internal ring, and the redund- 
ant portion cut off about a centimeter below the ligature. 
The cord is now held up out of the wound by a strip of sterile 
gauze, and the conjoined tendon sutured to the deep shelving 
of Poupart's ligament by four or five sutures. It has been 
advised to place one suture above the cord, as this is the point 
at which the recurrence is most likely to occur. None of these 
sutures should be tied too tightly, as strangulation of the 
tissues greatly favors infection and interferes with primary 
union, which is absolutely essential to the success of the 
operation. The cord is now laid upon its newly-formed bed 
(after resection of some of the veins if necessary), and the cut 
edges of the aponeurosis of the external oblique are united 
by a continuous suture. Great care should be taken to pre- 
vent any suture interfering with the circulation in the cord. 
The cutaneous wound is then closed with a subcuticular stitch 
and an aseptic dressing applied. The deep sutures should 
consist of kangaroo tendon, the superficial ones of chromi- 
cized cat-gut. If the operator is not sure of the asepticity of 
the tendon or cat-gut, silk sutures should be employed. 

Give the differential diagnosis of abscess. 

If an abscess is present there will be a history of a preced- 
ing inflammation, fluctuation, a tendency to point, an absence 



416 SURGERY. 

of thrill, an absence of bruit, a febrile temperature (as a 
rule) , and an examination of the blood usually reveals a poly- 
morphonuclear leukocytosis. If the abscess lies over a blood- 
vessel it may have an up-and-down pulsation, but if the 
abscess is pushed to one side this pulsation ceases. In such a 
case the abscess will not change in size if pressure is made 
upon the vessel above or below the abscess. The exploring 
syringe reveals pus. 

Aneurysm : If an aneurysm is present there will be no his- 
tory of a preceding inflammation, fluctuation is rare, the 
swelling preserves its fusiform or rounded shape, showing no 
tendency to point, thrill and bruit are present, the pulsation 
is expansile, the swelling cannot be moved from the line of 
the blood-vessel, pressure above the aneurysm decreases its 
size and expansile force, pressure below the aneurysm in- 
creases its size and expansile force, there may be a difference 
in the pulse to the distal side of the aneurysm as compared 
with the corresponding vessel upon the opposite side, and 
leukocytosis and fever are absent (unless the sac is inflamed). 
The exploring syringe reveals blood. 

Cysts : The overlying tissues are not edematous, nor is there 
a history of a preceding inflammation. The exploring syringe 
is of value in doubtful cases. 

Tumors: The only tumor apt to be confused with an ab- 
scess is a rapidly growing sarcoma (small round cell). Al- 
though these tumors may fluctuate, inflammatory symptoms 
are absent, and the exploring syringe reveals a bloody fluid. 

Describe intermediate and secondary hemorrhage, giv- 
ing both preventive and curative treatment of each. 

By intermediate hemorrhage is meant a hemorrhage recur- 
ring within twenty-four hours of an accident or operation. 

Preventive treatment: The proper method of tying the 
ligatures (surgeon's knot), which should include the artery 
alone, and not the surrounding tissues. All bleeding points 
should be carefully and completely controlled at the time of 



SURGERY. 417 

the accident or injury, and stimulants should not be injudi- 
ciously employed. 

Curative treatment: Elevation and pressure. If these 
measures are not successful, the wound should be opened up, 
irrigated with hot sterile saline solution, and all bleeding 
points tied. If ligatures cannot be applied, the actual cau- 
tery may be employed, or the wound may be packed with 
antiseptic gauze. 

By secondary hemorrhage is meant any hemorrhage occur- 
ring in a wound after the lapse of twenty-four hours from 
the time of the injury or operation. 

Preventive treatment: Thorough asepsis, the proper appli- 
cation of ligatures to all bleeding points, and the avoidance 
of the injudicious use of stimulants. 

Curative treatment: This will depend upon whether the 
hemorrhage comes from the end of a divided artery (as in a 
stump) or whether it comes from an artery which has been 
ligated in its continuity. 

If the hemorrhage comes from the end of a completely 
divided artery (as in a stump), elevation, exposure to the air, 
irrigation with hot sterile saline solution, and firm bandaging 
may suffice in the milder cases. If the hemorrhage recurs, 
the wound must be opened again, and the bleeding points 
ligated. If ligatures cannot be employed on account of the 
septic condition of the tissues, the actual cautery will be of 
service. All septic sloughs should be removed by the Volk- 
mann spoon, and the wound swabbed out with carbolic solu- 
tion (1-20) or with a solution of chloride of zinc (1-12). 
The wound should then be dusted with iodoform crystals, 
firmly packed with iodoform gauze, and a firm bandage 
applied. If the secondary hemorrhage occurs later in the 
case, the wound must be opened up, the bleeding vessel iso- 
lated from the surrounding structures, and ligated higher up. 
If this is impossible, the artery must be ligated still higher 
up, or a re-amputation performed. If the secondary hemor- 
rhage occurs after a shoulder or hip amputation, proximal 
27 



418 SURGERY. 

ligation is the only measure to rely upon should the local 
treatment fail. 

If the hemorrhage comes from an artery which had been 
ligated in its continuity, the same local treatment should be 
adopted as in the former instance. If this is unsuccessful, 
the treatment will depend upon the situation of the vessel. 
If the vessel is in the trunk (iliac) or neck (carotid) the 
wound must be opened up, the artery again ligated above and 
below, and the septic condition of the tissues combatted by 
packing with antiseptic gauze. If this fails, and proximal 
ligation is impossible, pressure will be the last resort. In 
the arm, if cold, pressure and elevation are without effect, 
the original wound must be enlarged, and the vessel tied 
above and below. If the hemorrhage still continues, the 
artery must be exposed and ligated higher up through an 
independent incision, or amputation will have to be per- 
formed. In the leg, a second ligature at a higher point is of 
questionable value on account of the poorer collateral circu- 
lation. Should it control the hemorrhage, gangrene will re- 
sult, and consequently amputation should at once be per- 
formed if the local measures are unsuccessful. 

State the differences between sthenic and asthenic in= 
flammatory fever. 

Sthenic inflammatory fever occurs in the young and in the 
robust. It rarely commences with a chill, the temperature 
rises to 102 degrees or 103 degrees F., delirium if present is 
maniacal, the pulse is full and strong, the skin is hot and dry, 
and constipation is present. 

Asthenic inflammatory fever occurs in the aged and in the 
debilitated. It usually commences with a chill, the temper- 
ature rises to 104° or 105° F., the delirium is low and mutter- 
ing, the pulse is rapid and weak, the skin is cold and clammy, 
and diarrhea is present. 

Differentiate dislocation of the head of the femur from 



SURGERY. 



419 



fracture of its neck, and give main essentials of treatment 
of each. 



Dorsal Dislocation. 

Inversion of foot. 

Immobility. 

Head of femur not felt in its natural 
position. 

The buttocks of the affected side are 
unduly prominent, due to the pres- 
ence of the head of the dislocated 
bone. 

Crepitus is absent. 



Intracapsular Fracture. 

Eversion of foot. 

Preternatural mobility. 

Head of femur felt in its natural 
position. 

Flattening of hip, the great trochanter 
moving in an arc of smaller radius, 
and relaxation of the ilio-tibial 
band. 

Crepitus may be elicited (unless im- 
paction is present). 

Immediate shortening of a half-inch, 
consecutive shortening of two or 
three inches. 

Much more common in advanced life 
and in the female. 

Violence usually trivial. 
Treatment. 

Reduction by extension and counter- 
extension. Buck's extension should 
be permanently employed. A sand- 
bag extending from the axilla to 
the external malleolus should then 
be placed upon the outer side of 
the extremity, and one extending 
from the groin to the internal mal- 
leolus upon the inner side of the 
extremity. 

In some cases it may be advisable to 
apply a plaster cast over the abdo- 
men and over the injured extremity 
to below the knee, and to allow the 
patient to change her position. In 
other cases the general condition of 
the patient makes it imperative to 
absolutely disregard the fracture. 

Describe a method of amputation of the thigh. 

The method giving the best results will generally be a flap 
amputation through the skin and a circular amputation 



Immediate shortening of two or three 
inches. 

Rarely occurs after forty-five, and 

more commonly in the male. 
Violence usuallv considerable. 



Reduction by flexion of leg upon 
thigh (for leverage), flexion of 
thigh upon abdomen (to relax Y- 
ligament), external circumduction, 
and extension. When reduction 
has been effected, the knees should 
be bandaged together, and the pa- 
tient kept in bed for two weeks. 



420 SURGERY. 

through the muscles (mixed method) . After all aseptic pre- 
cautions have been observed, and a tourniquet properly ap- 
plied, the surgeon takes his position upon the right side of the 
extremity to be amputated and makes a straight incision upon 
either side of the thigh. These incisions commence at the 
level at which the bone is to be divided; they are as long as 
the diameter of the limb at their point of origin, and they 
divide the skin and subcutaneous connective tissue. The 
lower ends of these incisions should be connected by a trans- 
verse cut of similar depth, and the corners of the flap rounded 
off. The centers of the two incisions should now be joined 
by a posterior transverse incision, the corners being rounded 
off as before. The anterior flap is now raised, and consists of 
nothing but skin and subcutaneous fat, excepting at its base, 
where a certain amount of muscular tissue should be included. 
The posterior flap is then dissected up, and should consist of 
nothing but skin and subcutaneous fat throughout. The 
muscles are now to be divided by a circular sweep of the knife. 
An assistant retracts the muscular tissue, a cuff of periosteum 
is raised, and the bone is sawn through as high up in the 
wound as possible (about one and one-half inches above the 
angles of junction of the flaps) . After the main vessels have 
been secured the tourniquet should be loosened and all bleed- 
ing points caught and ligated. Large nerves are drawn out 
and divided with scissors at the highest possible level, any 
projecting tendons are retrenched, and capillary hemorrhage 
is checked by hot sterile saline solution. The muscular tissue 
may then be sutured over the end of the bone if desired, and 
the edges of the flap united by interrupted sutures. The 
operation is concluded by the application of an aseptic 
dressing. 

Give the symptoms and treatment of luxation of the 
e!bow=joint with special reference to the prevention of 
ankylosis. 

The most frequent dislocation, that of both bones back- 
ward will be selected. 



SURGERY. 421 

Symptoms : The elbow is flexed, the forearm is midway be^ 
tween pronation and supination, and slight motion causes great 
pain. The olecranon and the head of the radius may be felt 
posteriorly while the lower extremity of the humerus is 
prominent anteriorly. The forearm is shortened and the 
olecranon projects above a line connecting the two condyles. 

Treatment: The patient is seated in a chair. The surgeon 
places his knee in the bend of the elbow and makes pressure 
against the lower end of the humerus, simultaneously fixing 
the forearm by grasping it just above the wrist. After 
maintaining this pressure for a short time the forearm is 
slowly but forcibly flexed upon the arm, the knee of the 
surgeon acting as a fulcrum and disengaging the coronoid 
process of the ulna from the trochlear surface of the hu- 
merus. The elbow is then put upon an angular splint or en- 
cased in a plaster of Paris bandage for two weeks after 
which passive motion and massage should be employed daily 
to prevent ankylosis. A lighter splint should be worn be- 
tween the periods of massage for at least one week longer. 

Outline the treatment for irreducible umbilical hernia. 

If any contra-indication to operation exists and there is no 
risk of strangulation some retentive apparatus may be worn. 

Practically all of these cases, however, should be operated. 
The entire hernial site is excised, the contents are reduced, and 
the abdominal wound is closed layer by layer. The patient 
should be kept upon her back until the union is firm and 
an abdominal belt may be worn for several months. 

Describe the operation of perineal prostatectomy. 

After all aseptic precautions have been carried out the 
patient is placed in the lithotomy position and an inverted 
V-shaped incision is made through the skin and superficial 
fascia, the apex of the V being over the posterior part of 
the bulb and the branches extending to a point midway be- 
tween the anus and the tuberosity of the ischium. The central 
tendon of the perineum and the Recto-urethralis muscle are 



422 SURGERY. 

divided so that the rectum may easily be retracted backward 
giving free access to the membranous urethra and the apex 
of the prostate gland. The membranous urethra is incised 
longitudinally upon a grooved staff, the edges are caught with 
forceps and Young's prostatic tractor is introduced and 
opened out. By pulling upon the tractor the prostate is 
brought well down into the wound and may be readily 
enucleated. By making two divergent incisions into the pros- 
tate as advised by Young, the ejaculatory ducts, and the floor 
of the urethra may be spared. If a median bar or lobe be 
present it may be made to project into one of the lateral 
cavities and also enucleated. In some cases the finger may be 
substituted for the prostatic tractor with advantage. 

Describe any one of the dislocations of the shoulder- 
joint. 

Subcoracoid dislocation. There is a flattening of the 
shoulder-joint, the head of the humerus being felt beneath the 
coracoid process. The vertical circumference around the 
axilla is increased (Callaway's sign). A ruler or straight- 
edge may be brought in contact with the tip of the acromion 
and the external condyle of the humerus simultaneously 
(Hamilton's sign) . If the hand of the dislocated extremity be 
placed upon the sound shoulder the elbow cannot be approxi- 
mated to the chest-wall (Dugas' sign). The elbow is away 
from the side and slightly posterior. The axis of the arm is 
altered. The patient is unable to touch the top of his head 
with the hand of the dislocated extremity. 

Give the diagnostic symptoms and the surgical treat- 
ment of congenital inguinal hernia. 

Symptoms : The sudden appearance of an inguinal swelling 
which soon extends into the scrotum. This swelling gives 
an impulse on coughing and when reduced flops back with a 
gurgle. It is not translucent. The hernia is always of the 
indirect variety. The hernial contents can not be differenti- 
ated from the testicle as readily as in a hernia of the ac- 



SURGERY. 423 

quired type. In a congenital inguinal hernia the testicle is 
at the bottom of the scrotum while in the acquired variety the 
testicle is on the posterior wall of the scrotum at the junction 
of the middle with the lower third. As in the acquired 
variety, the symptoms will also depend upon the nature of 
the hernial contents. A " congenital hernia" may develop 
at any period of life, it is only the sac which is present at birth. 

Surgical treatment: Bassini's operation (described else- 
where). Instead of removing the entire sac as in a typical 
Bassini, a tunica vaginalis is fashioned from its lower por- 
tion. The upper portion of the sac is ligated or sutured as in 
the ordinary operation for the radical cure of the acquired 
variety of inguinal hernia. 

Give the symptoms and treatment of acute ischiorectal 
abscess. 

Symptoms : Severe stabbing pain at one side of the rectum 
which is increased by defecation and digital examination. 
The patient is unable to sit squarely upon the buttocks but 
rests upon the healthy side allowing the inflamed area to pro- 
ject beyond the edge of the chair. Inspection reveals a 
hard brawny swelling at the side of the anus, which is ex- 
quisitely tender ; the overlying skin is reddened and edematous. 
The swelling soon softens and exhibits fluctuation upon pal- 
pation. A considerable amount of fever is usually present. 

Treatment: Free incision and the maintenance of gauze 
drainage so that the cavity will heal up from the bottom. 

Give symptoms and treatment of gun=shot and stab- 
wounds of the abdominal wall involving the intestines. 

Symptoms : The presence of a wound of entrance and pos- 
sibly also one of exit. The most characteristic symptoms of 
a wound of the intestine are localized pain and rigidity of the 
overlying muscles. The other symptoms are so variable that 
small dependence may be placed upon them. Shock may or 
may not be present. 

Treatment: "While a masterly inactivity may be justifiable 
in military practice, there is but one course for a competent 



424 SURGERY. 

abdominal surgeon to pursue when he can give his patient the 
advantages of thorough asepsis. After all aseptic precau- 
tions have been insured, the wound of entrance should be en- 
larged though it is usually best to make a median incision of 
sufficient length to allow the operator to quickly inspect the 
entire length of the intestinal tract. The small intestine 
should be followed from one end to the other, the assistant 
replacing the bowel as soon as the surgeon finishes his ex- 
amination so that only a single coil is exposed at any one 
time. The large intestine is then to be quickly but thoroughly 
examined. The possibility of an extraperitoneal wound 
should also be remembered. All perforations should be 
quickly closed by Lembert or purse-string sutures. If sev- 
eral perforations are close together, time may be gained by 
resecting the gut and making an end-to-end anastomosis by 
means of a Murphy button. If more than half of the lumen 
would be encroached upon by repairing a perforation, resec- 
tion is advisable. If these cases are operated upon early 
(within four hours) irrigation is not necessary. If extravasa- 
tion has occurred, however, the peritoneal cavity must be 
thoroughly irrigated with a large quantity of normal saline 
solution. Drainage may or may not be necessary. Thorough- 
ness and rapidity are indispensable to the success of the 
operation. 

Give the symptoms and treatment of fracture of the 
base of the skull. 

The general symptoms may be those of concussion, com- 
pression or laceration of the brain. 

The local symptoms will depend upon the cerebral fossa 
involved. 



In the anterior fossa, if the orbital plate be involved, there 
will be subconjunctival ecchymosis and possibly a certain de- 
gree of proptosis as the eyeball may be pushed forward by 
retrobulbar hemorrhage. If the cribriform plate of the eth- 
moid be involved, blood and cerebrospinal fluid will escape 
from the nose. Loss of smell may be present. 



SURGERY. 425 

In the middle fossa those signs will be present which have 
been previously described upon page 386. 

In the posterior fossa the symptoms are ill denned. There 
may be bleeding from the month or the blood may be swal- 
lowed and subsequently vomited. Deep-seated ecchymosis 
may become manifest among the muscles at the back of the 
neck. The cranial nerves .are rarely involved. 

Treatment : Absolute rest in bed. Perfect quiet, the exclu- 
sion of light and sound, a restricted diet and the administra- 
tion of a brisk mercurial purge. The external auditory 
meatus should be thoroughly disinfected, plugged with anti- 
septic gauze, and further protected by an antiseptic pad over 
the ear of the affected side. The nares and throat should be 
kept as clean as possible by the use of an antiseptic spray. 

Describe the varieties and the treatment of fractures 
of the patella. 

The ordinary fracture of the patella is due to muscular ac- 
tion. It is transverse, almost always complete, and the frag- 
ments are usually distinctly separated. 

The safest method of treatment is to fix the knee-joint, re- 
duce the intra-articular effusion by evaporating lotions, pres- 
sure, or aspiration and then to hold the fragments in position 
by the use of Agnew's posterior splint, adhesive plaster, and 
bandages. This treatment can effect only a fibrous union. 

The only way in which a perfect result may be secured is 
by making a free longitudinal incision over the fracture, re- 
moving the clots and fibrous tissue from between the ends of 
the fragments, drilling the fragments obliquely, and wiring 
them together. If rigid asepsis is not secured the patient 
may lose his leg or even his life. This is the treatment to be 
adopted in young active patients whose livelihood depends 
upon a perfect functional result. If the patient be past middle 
age and of sedentary habits the treatment with the posterior 
splint and the resulting fibrous union may be perfectly satis- 
factory to him if he does not care to assume the risk of the 
operative procedure. 



426 SURGERY. 

The second and rarer variety of fracture of the patella is 
that due to direct violence. It is usually stellate but may be 
oblique, longitudinal, or even transverse. It is frequently in- 
complete and the fibrous expansion of the Quadriceps may not 
be torn, so that the fragments are not displaced. The over- 
lying tissues are bruised and swollen. 

The posterior splint and evaporating lotions usually give 
good results in these cases. They are not so favorable for 
operation on account of the contusion of the overlying 
tissues. It is exceptional that operation is required for a 
fracture of this type. 

Describe the treatment for fracture of the shaft of the 
femur at the middle third. 

These* fractures are to be treated with a long external splint 
provided with a foot piece (Desault's), by three shorter splints 
applied to the circumference of the thigh, and by extension. 
The bed should be hard and firm. The foot is firmly ban- 
daged to the foot-piece by a figure-of-8 bandage, all bony 
prominences being carefully padded. The short splints are 
then applied to the anterior, inner and posterior aspects of the 
thigh and should extend to the knee-joint or slightly beyond 
it. They are to be held in position by two broad pieces of 
elastic webbing. An assistant now makes traction upon the 
splint until the deformity is reduced and the extremity is of 
the same length as its fellow. The pieces of webbing are 
then tightened and secured, and the upper portion of the 
splint is fixed to the body of the patient, preferably by a 
broad piece of muslin which is sewn to the splint, passes be- 
neath the body of the patient and then brought back to the 
splint where it is secured. This broad piece of muslin pre- 
vents anterior displacement of the splint. In addition to 
this, most surgeons prefer to make permanent extension, the 
stirrup for which is applied before the extremity is fixed upon 
the external splint. Union should be secured in about eight 
weeks but no weight should be born upon the extremity until 
the end of the twelfth week. 



SURGEBY. 427 

Describe suprapubic lithotomy. 

A silver catheter is introduced into the bladder which is 
to be filled with about ten ounces of a 3% solution of boric 
acid. Some surgeons still distend the rectum by the intro- 
duction and subsequent filling of a rubber bag. This is 
hardly necessary, but if the operator employ the rectal bag 
it should never contain more than 8 ounces, it should be 
inserted ofter the catheter has been introduced into the 
bladder, and before the bladder is distended with the boric 
acid solution. An incision about 2% inches in length is made 
in the median line just above the symphysis and is subse- 
quently carried down to the areolar tissue in front of the 
bladder. If the peritoneum bulges into the upper angle of 
the wound it should be displaced upward out of harm's way. 
There should be no difficulty in recognizing the bladder when 
distended and containing the curved end of the silver catheter. 
Two silk ligatures are now passed through the bladder-wall 
and the bladder is opened between them by a quick thrust 
of the knife. The index-finger is passed into the wound and 
locates the stone, which is to be removed by the finger, by the 
scoop, or by forceps. 

Give the symptoms and treatment of any one form of 
acute intestinal obstruction. 

Strangulated hernia. Symptoms: Pain at the hernial ori- 
fice and radiating toward the umbilicus. The hernia is hard, 
tense, and gives no impulse on coughing. Vomiting which is 
projectile, without preceding nausea, at first gastric, then 
bilious and soon assuming a stercoraceous character. Abso- 
lute constipation. Shock. Subnormal temperature. 

Treatment: Immediate herniotomy. 

Give any one of the dislocations of the knee=joint and 
the method of reduction. 

The anterior dislocation of the upper end of the tibia. 
The thigh should be flexed upon the pelvis, extension is 
made upon the leg, and the surgeon endeavors to bring the 



428 SURGERY. 

bones into their normal relations by pressure and manipula- 
tion. The parts should be massaged from the first, but 
passive motion should not be employed until the end of the 
second week and then with great caution. The patient should 
subsequently wear an artificial knee-cap to prevent a recur- 
rence of the displacement. 

Define necrosis and give the cause and surgical treatment. 

By necrosis is meant the death of bone en masse. 

Causes. Denudation of periosteum. Periostitis, ostitis, or 
osteomyelitis. Tuberculosis. Syphilis. Exposure to the 
fumes of phosphorus. The excessive administration of 
mercury. 

Surgical treatment: Sequestrotomy. 



OBSTETRICS AND GYNECOLOGY. 



Describe the female reproductive organs. 

The ovaries are two small almond-shaped organs situated 
one on either side of the uterus (described below) and at- 
tached to the posterior surface of the broad ligaments. Each 
is 4 cm. long, 2 cm. broad and 1-% cm. thick, and weighs 6.4 
gm. (100 grains). It consists of the oophoron or egg-bearing 
portion and the paroophoron or fibrous portion. 

The oviducts or Fallopian tubes are the trumpet-shaped 
structures attached to the uterine cornua. Each tube is about 
liy 2 cm. long, and surrounds the corresponding ovary. The 
outer end is the fimbriated extremity. The tube is lined with 
ciliated epithelium, which facilitates the passage of the ovum 
to the uterus. 

The vagina or organ of copulation is the passage from the 
vestibule to the cervix. It lies at an angle of 60° to the hori- 
zon. It has two walls, anterior and posterior. Its mucous 
membrane lies in folds or rugae. 

The hymen is the fold of vaginal mucous membrane guard- 
ing the lower orifice of the vagina. 

The vulva or external genitals includes the labia majora, 
labia minora, clitoris, vestibule and mons veneris. The labia 
majora. are the fleshy folds on either side of the vestibule; 
the labia minora or nymphse are the two small mucous folds 
situated within the greater lips; they unite above to form 
the prepuce of the clitoris. The latter is the analogue of the 
penis. The vestibule is the triangular space bounded above 
by the clitoris, laterally by the labia minora, and below by the 
orifice of the vagina. The mons veneris is the fleshy eminence 
above the symphysis pubis. 

(429) 



430 OBSTETRICS AND GYNECOLOGY. 

Give a description of the physiology of menstruation. 

Menstruation is a periodic series of phenomena occurring 
normally every 28 days in the non-pregnant female from 
puberty to the menopause, consisting of certain symptoms 
(menstrual molimina) and a characteristic sero-sanguinolent 
discharge derived from the congested mucosa of the tubes 
and uterus. The process consists in a growth of the stroma 
of the uterine mucosa and a breaking down of the congested 
vessels, with consequent formation of lacuna, which rupture. 

What is the duration of menstruation and what are the 
resulting changes in the uterine mucous membrane? 

Menstruation normally lasts 3 or 4 days. It is accom- 
panied by a growth in the stroma of the uterine mucosa, or 
congestion of the vessels which rupture, and a subsequent 
degeneration of the superficial layers of the mucosa. 

What is vicarious menstruation? 

A periodic discharge of blood or other fluid from the nose, 
breast, stomach, or other organ during a period of suppressed 
menstruation. 

What are the abnormalities of menstruation and give 
their etiology and treatment. 

The abnormalities of menstruation are: Amenorrhea, or 
absence of the menstrual fluid ; scanty menstruation, or insuffi- 
cient flow; menorrhagia, or excessive flow at the menstrual 
periods; metrorrhagia, or a flow between the periods; and 
dysmenorrhea, or painful menstruation. Amenorrhea results 
from anemia, chlorosis, phthisis, nervous and mental dis- 
eases, change of climate, and uterine and ovarian defects of 
development. It is treated by diet, exercise, iron, tonics, 
arsenic, and the so-called emmenagogues. Menorrhagia and 
metrorrhagia result from endometritis, tumors, salpingitis 
and other causes of pelvic congestion, including subinvolu- 
tion after labor. They may be treated by astringents inter- 
nally, as hydrastis, ergot, oil of erigeron, thyroid extract, and 
mammary extract, or by local treatment, including curettage. 



OBSTETRICS AND GYNECOLOGY. 431 

Dysmenorrhea requires dilatation and curettement and re- 
placement of displaced organs. 

What conditions have a bearing on the time of life in 
the female when menstruation first occurs? 

Race, social development, climatic influences and predis- 
position. The average age of puberty in this country is about 
the fourteenth year. 

What is the placenta? From what is it formed, what 
is its structure and what are its functions? 

The placenta is the essential nutritive and respiratory organ 
of the fetus. It is formed from the chorion frondosum and 
the decidua serotina, and assumes its functions by the end of 
the third month. 

Describe the development of the placenta. 

During the rapid development of the chorion frondosum, 
or hairy chorion, a corresponding change takes place in the 
decidua serotina; its tissues hypertrophy and become thick, 
spongy and very vascular. The chorionic villi sink deeply 
into this pulpy mass and become intimately connected with it, 
permitting of osmosis or interchange of the maternal and 
embryonic blood. By the third month these structures have 
developed into the fully formed placenta. 

What are the functions of the placenta? 

1. The supplying of nourishment from the mother to the 
fetus. 2. The oxygenation of the impure fetal blood. 3. 
The excretion of the effete products from the fetus. 

Describe the human uterus and give its anatomic 
relations. 

The uterus is a hollow muscular organ situated in the cen- 
ter of the pelvis and embraced between the folds of the broad 
ligaments. It is 7% cm. long, 4 cm. broad, and 2% cm. thick; 
it weighs 31 grams (7 drams). The upper portion above the 
point of entrance of the Fallopian tubes is the fundus, the 
portion between the tubes and the internal os is the body 



432 OBSTETRICS AND GYNECOLOGY. 

proper, and that between the internal and external os is the 
cervix. The flattened anterior surface is in close juxtaposi- 
tion with the bladder ; the posterior surface is separated from 
the rectum by Douglas' pouch or cul-de-sac. The cavity of 
the uterus measures 6% cm. (2y 2 in.). 

How is the uterus supplied with nerves? 

The uterus is supplied by filaments from the hypogastric 
and ovarian plexuses of the sympathetic nervous system. 

Describe the normal non=gravid uterus, giving its func= 
tions and relation to the other organs of generation. 

The uterus has already been described. It lies above the 
vagina, its axis being at right angles to the axis of the vagina. 
The tubes are continuous with the cornua, and extend one to 
either side of the fundus. The ovaries are on either side of 
the uterus below the tubes. 

Describe the semen. 

The semen is a thick, viscid, yellowish or opalescent fluid, 
with a faint characteristic lime-like odor, secreted by the tes- 
ticles and prostate gland. Its most important constituents 
are the spermatozoids. 

Define insemination and state the conditions necessary 
to its accomplishment. 

Insemination is the deposit of the semen within the vagina 
during copulation. It is not necessarily followed by impreg- 
nation. 

What are spermatozoa? Where are they found? De= 
scribe their appearance and function. 

The spermatozoa are microscopic, tadpole-like bodies pres- 
ent in immense numbers in the semen. They are about 1-500 
of an inch in length, and are derived from the sperm- cells of 
the seminal tubules of the testicles. They have flat, oval 
heads, small bodies, and immensely elongated flagella or tails, 
which are in constant motion. Their function is fertilization 
of the ovum. 



OBSTETRICS AND GYNECOLOGY. 433 

Give the definition, physiology and frequency of ovu!a= 
tion and state whether ovulation and menstruation are 
synchronous. 

Ovulation is the formation, development and discharge of 
a mature ovum from the ovary. It occurs once or twice in 
a month, and is not necessarily synchronous with menstru- 
ation. 

What is the mechanism of the escape of the ovule and 
its transmission to the tubes and uterus? 

Upon the establishment of puberty certain Graafian folli- 
cles assume extraordinary growth, and rapidly approach the 
ovarian surface. Owing to the increased intrafollicular pres- 
sure the capsule yields and the contents — an ovum and the 
liquor folliculi — escape. The ovum is received into the Fal- 
lopian tube either by direct introduction at the time of rupture 
or by suction, and is then carried into the uterine cavity by 
the action of the ciliated epithelium of the tube. 

Define fecundation and describe its physiology. 

Fecundation is the fertilization of the ovum by the sper- 
matozoids. It is accomplished according to some in the tubes 
or on the ovarian surface, and according to others in the 
uterine fundus. The spermatozoids penetrate the vitelline 
membrane of the ovum through the micropyle. The ovum 
then undergoes a series of progressive changes. 

Give the successive changes that take place in the ovum 
after fecundation, and during its passage to the uterus. 

1. Absorption of the vibratile extremity of the spermato- 
zoid, leaving the head only, which is known as the male pro- 
nucleus. 2. Union of the male and female pronuclei to form 
the oosperm or blast o sphere. 3. Division of the vitelline nu- 
cleus, followed by segmentation of the vitellus, resulting in 
the formation of the morula or mulberry mass. 4. Appear- 
ance in the center of the morula of a transparent fluid, which 
condenses the morula into a thin cellular layer (blastoderm 
or blastodermic membrane). 5. Division of the blastoderm 
28 



434 OBSTETRICS AND GYNECOLOGY. 

into the epiblast, mesoblast and hypoblast. 6. Aggregation 
of the hypoblastic cells into the germinal or embryonic area. 

7. Appearance in this of the primitive trace or embryonic 
line, surrounded by a translucent space, the area pellucida. 

8. Incurving of the extremities of the primitive trace to form 
the fetal ellipse. 9. Development of the embryonal parts. 

Describe the vitellus, the allantois, and the amnion. 

The vitellus is the protoplasmic yelk of the ovum. The 
allantois is a small pear-shaped vesicular structure which 
develops from the lower portion of the embryonic alimentary 
canal at about the 20th day of intra-uterine life. It is a vas- 
cular structure, and is the forerunner of the placenta. It is 
intimately associated with the chorion. The amnion is a 
smooth, tough, transparent, glistening, fibrous structure, the 
innermost of the fetal membranes, surrounding the fetus and 
continuous with it at the umbilicus; it secretes and encloses 
the liquor amnii. 

Describe the fully developed ovum. 

The ovum is the vital element or reproductive cell of the 
female. It varies in size from 1-500 to 1-120 of an inch. It 
consists of a protoplasmic yelk or vitellus and a nucleus or 
germinal vesicle (vesicula germinativa) enclosed within a 
hyaline covering, the zona pellucida or vitelline membrane. 

What is the character of the liquor amnii and what are 
its sources and uses? 

The liquor amnii is an alkaline fluid, about a quart in 
quantity, with a light specific gravity, an opaque white color, 
and a characteristic odor. It prevents undue pressure of the 
uterine walls upon the fetus, it saves the uterus from injury 
due to the fetal movements, it maintains an equable temper- 
ature around the fetus, and it receives and dilutes the excre- 
tions of the fetus. It is derived from the fetus largely, and 
contains much fetal urine. 

What is the umbilical cord and how is it formed? 

The funis or umbilical cord is a cord-like structure extend- 



OBSTETRICS AND GYNECOLOGY. 435 

ing from the umbilicus of the fetus to the placenta. It is 
developed from the pedicle of the allantois at about the fourth 
week of pregnancy. It measures at term about 50 cm. in 
length. 

What structures compose the fully developed umbilical 
cord? 

Two umbilical arteries, one umbilical vein, the vitelline 
duct, the pedicle of the allantois, and the jelly of Wharton. 

What are uterine hydatids (hydatid pregnancy) ? What 
are their source and treatment? 

This is an unusual name for hydatidiform mole or cystic 
disease of the chorion, a rare affection of the chorion consist- 
ing in a proliferative degeneration of the chorionic villi with 
the production of a mass of grape-like vesicles attached to the 
placenta. The disease occurs about once in 2000 cases of 
pregnancy. The treatment consists in immediate evacuation 
of the uterine contents. 

What changes take place in the female at puberty? 

Hair appears above the pubis ; the breasts develop ; the 
function of ovulation is established; menstruation appears; 
the pelvis widens ; and there is a growth of the sexual sense. 

What are the differences between the male pelvis and 
the female pelvis? Give the importance of the female 
characteristics in labor. 

Male. Heavy structure. Cavity deep and contracted. 
Sacrum narrow and slightly curved. Ischial tuberosities 
closely approximated. Subpubic angle 75°-80°. Pelvic brim 
triangular. Slight pelvic inclination. Thyroid foramen 
oval. 

Female. Light structure. Cavity shallow but roomy. 
Sacrum wide and deeply curved. Ischial tuberosities widely 
separated. Subpubic angle 90°-100°. Pelvic brim cordate. 
Great pelvic inclination. Thyroid foramen triangular. 

The female characteristics favor ready transit of a fetus 
through the pelvis. 



436 OBSTETRICS AND GYNECOLOGY. 

Give the bones, divisions, straits and symphyses of the 
obstetric pelvis. 

The pelvis is composed of the two innominate bones, the 
sacrum and the coccyx ; it is divided into the true pelvis below 
and the false pelvis above the iliopectineal line. This line 
forms the boundary of the inlet or superior strait. The lower 
orifice is the inferior strait. The symphyses are three in num- 
ber, viz., the pubic, and the two sacro-iliac synchondroses. 

Give the obstetric landmarks of the superior and infe= 
rior straits. 

Superior strait. The four cardinal points, viz., the sacro- 
iliac synchondroses, and the iliopectineal eminences; also the 
promontory of the sacrum, and the iliopectineal line. Infe- 
rior strait. The tips of the coccyx, the ischial tuberosities, 
and the subpubic angle. 

Give the names and dimensions of the diameters of the 
pelvic inlet. 

The conjugate or anteroposterior, 11 cm. ; the transverse, 
13y 2 cm., and the two oblique diameters (between one ilio- 
pectineal eminence and the opposite sacro-iliac synchon- 
drosis), 12% cm. 

What are the diameters of the pelvic outlet? How is 
the pelvic outlet bounded? 

The transverse (between the ischial tuberosities) 11 cm., 
and the conjugate (between the tip of the coccyx and' the sub- 
pubic ligament) 9% cm. at rest, and 11 cm. in labor. The 
pelvic outlet is bounded by the tip of the coccyx, the ischial 
tuberosities, the sacrosciatic ligaments, the thyroid foramina, 
and the subpubic ligament. 

Differentiate the planes and axes of the pelvis and men= 
tion their obstetric importance. 

The plane of the superior strait forms an angle of 50°-60° 
with the horizon ; the plane of the inferior strait forms a line 
of 10° with the horizon. The roomiest portion of the pelvic 



OBSTETRICS AND GYNECOLOGY. 437 

cavity forms what is known as the plane of pelvic expansion, 
while the narrowest portion of the cavity forms the plane of 
pelvic contraction. The axis of the pelvic cavity, known as 
the curve of Cams, extends from the middle of the plane of 
the superior strait to the middle of the plane of the inferior 
strait, and follows the curve of the sacrum. The greater its 
curvature, the more difficult the labor; also the greater the 
pelvic obliquity, the more difficult the labor. 

What are the varieties of deformed pelvis? 

The most commonly recognized varieties are the simple 
flat, the spondylolisthetic, the rachitic, the coxalgic, the sco- 
liotic, the osteomalacic, Naegele's, Robert's, the kyphotic, the 
kyphoscoliotic, the justo-minor, the generally contracted and 
flat, the justo-major, the split pelvis, and the pelves distorted 
by tumors and fractures. 

What difficulties arise during labor from malformations 
of the maternal pelvis? 

If the pelvis be increased in size a precipitate labor will 
probably result. If it be contracted there will occur all de- 
grees of obstruction, from the slightest retardation to total 
blocking of the fetal progress. This will result in increased 
severity of the labor pains, rise of the contraction-ring, early 
escape of the liquor amnii, serious compression of the fetal 
head, malpositions and malpresentations of the fetus, and 
sloughing of the maternal soft parts. 

What varieties of deformed pelvis are liable to interfere 
with obstetric procedures? How? 

All pelves that are contracted in the superior or inferior 
straits will more or less seriously obstruct labor. This in- 
cludes the vast majority of deformed pelves, whatever the 
cause of the deformity. 

Describe and differentiate pusto=minor pelvis and justo= 
major pelvis, and state how each may complicate labor. 

The justo-minor pelvis is one equally contracted in all of 



438 OBSTETRICS AND GYNECOLOGY. 

its diameters; it is normal in shape, but undersized. The 
justo-major pelvis is one equally enlarged in all its diameters. 
The former obstructs labor ; the latter predisposes to precipi- 
tate labor. 

Describe a nonrachitic flat pelvis, and give the man- 
agement of labor in such a condition. 

This is a very common form of pelvic deformity, consisting 
in a diminution in the anteroposterior diameter of the supe- 
rior strait of the pelvis without any disturbance in the size of 
the other diameters. As a rule, it does not result in serious 
interference of labor, although instrumental delivery may be 
required. 

What structures enter into the formation of the pelvic 
floor? 

From without inward the muscles of the pelvic floor are the 
transversus peronei, the ischiocavernosus, the sphincter ani, 
the sphincter vaginae, the coocygeus, and the levator ani mus- 
cles, together with the pelvic fascia and the perineal wedge 
or body. 

What changes occur in the uterus during pregnancy? 

There is a general hypertrophy of all the uterine tissues, 
especially of the muscular substance. The blood-vessels are 
increased in number, size, length and tortuosity. The veins 
lose all their coats but the intima. The uterus slightly ro- 
tates on its axis from left to right during its development. 

What are the effects of pregnancy on the material 
organisms? 

In addition to the uterine changes already described there 
will be noted the following : A deposit of fat in the abdominal 
wall, an edema of the joints of the pelvis, congestion of the 
pelvic viscera, an increase in the quantity of blood and of the 
urine, alterations in taste and disposition, and a softening of 
the bones of the entire body. 



OBSTETRICS AND GYNECOLOGY. 439 

What changes occur during pregnancy in the external 
genitals and vagina? 

There will be noted an increased vascularity, with edema 
and softening of the tissues, and a bluing of the mucous mem- 
brane. 

What changes occur in the breasts during pregnancy? 

The breasts become enlarged generally and much engorged, 
and a deposit of pigment takes place in the areola. This pri- 
mary ring of pigment may be surrounded by a secondary 
areola of light color. The glands of Montgomery become 
enlarged and protuberant. The nipples become prominent, 
and colostrum develops in the mammary glands. 

What changes occur in the blood during gestation? 

The general quantity of the blood is increased, while its 
quality decreases; in other words, there exists a combined 
hydremia and anemia. There is an increased tendency to 
clot from the large amount of fibrinogen present. 

Describe the human embryo during the second month, 
during the fifth month, during the seventh month, and 
during the ninth month, giving size and weight. 

At the second month the embryo is the size of a pigeon's 
egg; the visceral clefts are closed; the head forms more than 
two-thirds of the embryo, and all its features may be distin- 
guished; the hands and feet are webbed; the length of the 
fetus is 4 cm. (1% inches) ; its weight is 4 grams (60-62 
grains) . 

At the fifth month the face is wrinkled and senile, the hair 
and nails are fully formed, the vernix caseosa appears, the 
eyelids begin to open; the umbilical cord is about 12 inches 
long; the length of the fetus is about 25 cm. (9% inches) ; 
its weight 273 grams (10 8-10 ounces). 

At the seventh month the skin is still wrinkled and reddish, 
the lanugo begins to disappear from the face, the eyelids are 
open, the membrana pupillaris disappears; the length of the 



440 OBSTETRICS AND GYNECOLOGY. 

fetus is 35 cm. (13% inches) ; its weight 1213 grams (39 
ounces). 

At the ninth month the senile appearance of the face dis- 
appears, the lanugo begins to disappear from the body; the 
length of the fetus is 45 cm. (17% inches) ; its weight 1990 
grams (5% pounds). 

Name the diseases of the fetus and its membranes in 
utero. 

The fetus may suffer from various infectious diseases trans- 
mitted to it through the placental circulation; rarely it may 
develop tuberculosis in this way; fetal rickets is a common 
condition, as is also fetal syphilis; very rarely the fetus may 
develop tumors in various portions of the body; maternal 
impressions may be noted; and various intracranial diseases, 
as meningocele, hydrocephalus and the like; fetal ichthyosis 
is rarely noted. The diseases of the membranes include 
hydramnios, oligohydramnios, and cystic disease of the cho- 
rion. 

How would you diagnose the death of the fetus in utero? 

In about the order of value the signs of fetal death are : 1. 
Cessation of abdominal and uterine growth, followed by sub- 
sidence in the size of the uterus. 2. Subsidence of the signs 
of pregnancy. 3. Absence of fetal heart-sounds and fetal 
movements. 4. Absence of pulsation in the umbilical cord or 
fetal precordium. 5. Decrease in the cervical temperature. 
6. Appearance of milk in the breasts (occasional). 7. Pep- 
tone or acetone in the urine. 8. Cranial crepitus in case of 
maceration of the fetus. 

How may death of the fetus in utero be recognized after 
the period of viability? What should be done in such 

cases? 

Fetal death may be presupposed by a suppression of all 
the signs of pregnancy that have been present; by absence 
of the fetal heart-sounds; by cessation of the growth of the 
abdomen, with subsequent diminution in the size of the 



OBSTETRICS AND GYNECOLOGY. 441 

abdominal girth, and occasionally by the appearance of milk 
in the breasts. When fetal death is assured the uterine con- 
tents should be removed. 

Give the obstetric anatomy of the fetal head. 

The fetal head at term consists of the two frontal bones, 
the two parietal bones, the occiput and the bones of the face. 
These various bones are separated by sutures, as follows; 
The frontal, the sagittal, the coronal, the lambdoid, and by 
the two fontanels, the anterior and the posterior. 

Name the various diameters of the fetal head. 

The diameters of the fetal head are as follows : The bitem- 
poral, 8 cm. ; the biparietal, between the two parietal emi- 
nences, 9% cm. ; the bimastoid, between the two mastoid 
processes, 7% cm. ; the occipito-f rontal, from the root of the 
nose to the external occipital protuberance, 11% cm. ; the 
occipito-mental, from the point of the chin to the external 
occipital protuberance, 13% cm. ; the suboccipito-bregmatic, 
from the central point of the bregma to a point midway be- 
tween the occipital protuberance and the foramen magnum, 
9% cm. ; the f rontomental, from the top of the forehead to the 
point of the chin, 8 cm. ; the trachelo-bregmatic, from the 
central point of the bregma to the anterior margin of the 
foramen magnum, 9y 2 cm. ; and the mento-bregmatic or 
cervico-bregmatic, from the central point of the bregma to 
the junction of the chin and neck, 9*4 cm. 

Describe the fontanels and their diagnostic uses. 

The anterior or larger fontanel or bregma is a diamond- 
shaped space left at the point of junction of the frontal, 
coronal and sagittal sutures. The posterior or smaller fon- 
tanel is situated at the point of junction of the lambdoid and 
sagittal sutures, and is triangular in shape. It is felt in all 
normal vertex presentations, and by its situation determines 
the position of the head in labor. The bregma is never felt 
in a normal presentation, but may be palpated in the presen- 
tation of the top of the head, in a brow presentation, and in 
presentation of the occiput in the hollow of the sacrum. 



442 OBSTETRICS AND GYNECOLOGY. 

What is meconium and what are its diagnostic relations? 

Meconium is the peculiar greenish substance contained in 
the fetal bowels at birth. If it be discharged prior to the 
delivery of the child, it generally indicates a breech pre- 
sentation. Occasionally it will escape in difficult head- 
deliveries. 

Describe the fetal heart=sounds, give their rate, and 
state when and where they are best heard. 

The fetal heart-sounds constitute an absolute sign of preg- 
nancy from the sixth month of gestation on. They resemble 
the ticking of a watch under a pillow; their rate is about 
twice that of the maternal heart-beat, averaging from 120 to 
160 beats a minute. The position of maximum intensity 
varies according to the fetal presentation. In anterior ver- 
tex presentations they are best heard at a point midway be- 
tween the umbilicus and the anterior spinous process of that 
side upon which the fetus is resting, while in posterior vertex 
presentations the point of maximum intensity would be in 
the corresponding flank, slightly below a transverse line pass- 
ing through the umbilicus. 

What is ballottement, and how is it performed? 

Ballottement is a balancing of the fetus in utero between 
the fingers of the two hands. In vaginal ballottement the 
index and middle fingers of the left hand are inserted into the 
anterior vaginal fornix, the patient lying in the dorsal posi- 
tion, while the fundus is steadied by the right hand placed 
upon the abdomen. The vaginal fingers give a sudden im- 
pulse to the anterior uterine wall, whereby the fetus is dis- 
placed upward ; the latter gently falls back and strikes upon 
the propelling fingers. This sign is positive, and is available 
from the middle of the fourth to the eighth months. 

How would you diagnose pregnancy at five months, at 
or before the end of the third month, and at full term? 

In the first three months of pregnancy the following signs 
are present: Menstrual suppression, nausea and vomiting, 



OBSTETRICS AND GYNECOLOGY. 443 

and the four soft signs, viz., G-oodell's sign (softened cervix), 
Hegar's sign (softened lower uterine segment), the soft and 
boggy uterine body, and the soft and enlarged mammas, with 
the darkened areolae. 

At the fifth month there will be added to the foregoing 
Jacquemin's sign (the bluing of the vaginal and vulvar 
mucosas), Braxton Hicks' intermittent uterine contraction, 
ballottement, and quickening; the uterus will also be con- 
siderably more enlarged. 

At term all the foregoing signs are present, save ballotte- 
ment, and in addition the fetal heart-sounds may be detected, 
and palpation will reveal the fetal outlines both above and 
below. 

What are the subjective signs of pregnancy? 

The subjective signs of pregnancy are those recognized by 
the patient herself. This includes menstrual suppression, 
nausea and vomiting, vesical irritability, quickening, pain in 
the abdominal walls from excessive distension, vertigo, palpi- 
tation, and gastric disturbance. 

What signs of pregnancy are determined by the touch? 

The four ''soft signs, ,J the fetal parts and presentation, 
ballottement, Braxton Hicks' sign, the uterine enlargement, 
and the fetal movements. 

What may be learned by abdominal palpation of the 
pregnant woman after the eighth month? 

The fetal movements, the fetal parts, the position and pre- 
sentation of the fetus, the size and position of the uterus, the 
degree of distension of the uterine and abdominal walls, the 
size of the pelvic inlet, the movability of the fetal head. 

Classify the objective signs of pregnancy and state their 
relative value. 

The five positive signs of pregnancy are ballottement, fetal 
movements, fetal heart-sounds, blue discoloration of the vulva 
and vagina, and intermittent uterine contractions. Other 
valuable objective signs are cervical softness (in primiparae), 



444 OBSTETRICS AND GYNECOLOGY. 

Hegar's softening of the lower uterine segment, darkening 
of the areolae of the breasts, the presence of colostrum in the 
breasts, and the outlining of the fetal parts. 

What are the signs of pregnancy, doubtful, probable, 
and certain? 

The doubtful signs of pregnancy are vesical irritability, 
irregular gastric disturbances, increasing constipation, dimin- 
ution but not actual suppression of the menstrual flow, all 
occurring in a woman exposed to the possibility of impreg- 
nation. 

The probable signs are total menstrual suppression, in- 
creasing size of the uterus, darkening of the mammary 
areolae, development of Montgomery's tubercles, and fre- 
quency of micturition. 

The certain signs are the positive signs already enumerated. 

What is to be learned by abdominal auscultation in 
pregnancy? 

Auscultation of the abdomen will reveal the placental 
souffle or uterine bruit and the fetal heart-sounds. Occasion- 
ally the umbilical souffle may be detected. 

Describe the changes in position which the uterus under- 
goes during pregnancy. 

At first the uterus sinks into the pelvis on account of its 
increased specific gravity. There then follows a gradual and 
progressive rise into the abdomen until 2 to 4 weeks before 
term, when a secondary sinking {lightening) occurs, due to 
the entrance of the fetal head into the superior strait. 

At what period does quickening usually occur? 

In the middle of the fifth month of gestation. 

How should external palpation of the pregnant woman 
be performed? 

The woman lies in the dorsal position with the limbs partly 
flexed. General pressure is made with the tips of the fingers 
and the ulnar borders of the palms upon the abdominal sur- 



OBSTETRICS AND GYNECOLOGY. 445 

face from the median line towards the flanks. The hands 
are permitted to dip beneath the central points of Poupart's 
ligaments and beneath the pelvic brim in order to determine 
the fetal presentation. 

What is " morning sickness," when does it begin, how 
long does it usually continue, and" what is its causation 
and treatment? 

The nausea and vomiting of pregnancy occurs usually at 
the sixth week of gestation, and normally lasts for six weeks. 
It may begin earlier or it may not appear at all. It is be- 
lieved to be due to a reflex irritation of the nerve-endings in 
the uterus resulting from the rapid growth of that organ. 
It is best treated by the exhibition of nerve-sedatives, such as 
sodium bromide, ingluvin, oxalate of cerium and the like. 

Differentiate ordinary morning sickness from the hy= 
peremesis of pregnancy. Mention the causes and describe 
the management of the latter. 

The pernicious vomiting of pregnancy is an exaggerated 
gastric disturbance which appears to become uncontrollable, 
and may result fatally from extreme prostration. It is due 
to a number of conditions, including the presence of toxins 
of undetermined nature in the blood, probably resulting from 
imperfect functionating of the liver. It occurs in women 
whose uteri have been chronically diseased, and in those who 
are of a neurotic tendency. It may also result from kidney- 
failure, and from too frequent sexual intercourse. Its treat- 
ment consists in proper hygiene, the correction of uterine 
displacements or cervical catarrh, restriction in diet, the use 
of proper therapeutic measures, and, if need be, rectal ali- 
mentation. The pregnancy should be terminated if the other 
measures fail. 

What is the normal duration of pregnancy? What are 
the limits of the variations, and how should its duration 
be calculated? 

From a number of investigations it has been found that in 



446 OBSTETRICS AND GYNECOLOGY. 

the human being pregnancy normally covers 280 days (10 
lunar or 9 calendar months). It may be extended up to 302 
days and pregnancy still be considered legitimate. Fre- 
quently the pregnancy terminates prematurely, and this may 
happen at any time subsequent to 'conception. The methods 
of determining the date of confinement are numerous. The 
Naegele rule is to count back 3 months from the date of the 
appearance of the last menstruation and add 7 days. The 
date of quickening usually occurs midway through gestation, 
or at 4% months. Other methods consists in mensuration of 
the uterus and of the fetus, and the use of periodoscopes and 
tables. 

How would you differentiate between the first and 
subsequent pregnancies? 

In a primipara the fourchet is present; it is missing in a 
multiparous woman. The abdominal walls are relaxed and 
marked with striag in the multipara, while in the primipara 
the abdomen is full, rounded and tense. The nipples are 
large and well developed in the multiparous woman, and 
usually small and undeveloped in the primipara. 

Given a distended abdomen, how would you differen= 
tially diagnose pregnancy, ovarian disease, ascites, and 
gaseous accumulation? 

In ovarian cyst there is generally an absence of the chief 
signs of pregnancy; the characteristic ovarian facies is pres- 
ent; the abdominal tumor is soft, fluctuating, usually more 
or less directed to one side, and does not reveal the fetal signs ; 
continuance of menstruation is the rule; the cervix is not 
unduly soft; and the history is obscure, the growth slowly 
developing for a longer period than the full term of gestation. 

In ascites percussion shows dulness in the flanks, with re- 
sonance in the median abdominal line, the area of dulness 
changing with the position of the patient; there is free fluc- 
tuation; the usual signs of pregnancy are absent; the abdo- 
men is flattened in the umbilical region, with bulging at the 



OBSTETRICS AND GYNECOLOGY. 447 

sides; the umbilicus is always depressed; palpation does not 
reveal any definite tumor; the cervix is not altered. 

In gaseous accumulation or pseudocyesis, which most com- 
monly occurs in elderly women at or near the menopause or in 
young or hysterical women, some of the important signs of 
pregnancy will be absent ; the uterus is not enlarged, and the 
cervix is not soft; there is a tympanitic percussion-note over 
the whole abdominal surface, and if the patient be anesthe- 
tized the abdominal enlargement will disappear entirely. 

Differentiate uterine bruit and umbilical souffle. 

The uterine bruit or placental souffle is a rhythmic blowing 
sound occurring synchronously with the maternal heart-beat. 
It is first heard about the beginning of the fourth month, and 
is generally located low down and to one or the other side of 
the uterus. It is also known as the placental murmur. The 
umbilical or funic souffle is a peculiar high-pitched hissing 
sound heard most distinctly in the immediate vicinity of the 
fetal heart, with the beat of which it is synchronous. It is a 
sign of fetal danger, and indicates some stenosis of the um- 
bilical arteries. 

Describe the mammary glands and the changes they 
undergo in pregnancy. When the child is still=born what 
care should be taken of the mother's breasts? 

The mammary glands are two large glandular structures 
on the anterior surface of the thorax. They consist of a num- 
ber of lobules, each of which has an excretory or galacto- 
phorous duct which runs to the nipple. During pregnancy 
the breasts enlarge and become firm and heavy. Glistening 
streaks appear upon the surfaces from over-distension. Pig- 
ment is deposited around the nipple in the areolae ; the glands 
of Montgomery enlarge and protrude from the surface; the 
nipples increase in size and become prominent and protrud- 
ing. Colostrum appears in the breast after the third month. 
If the child is still-born the breasts must be strapped and 
applications made to prevent the development of milk. 



448 OBSTETRICS AND GYNECOLOGY. 

State the medicolegal complications that may arise from 
an erroneous diagnosis of pregnancy. 

An erroneous diagnosis of pregnancy may result in con- 
jugal unhappiness, with divorce; it may cause the execution 
of an innocent woman or unnecessary confinement in prison ; 
it may alter the terms of a will or the dividing of an estate ; 
it may bring a law-suit 'against the physician. 

What are the positions and attitudes of the fetus in 
utero, and what are their causes? 

The fetus may lie parallel with or at right angles to the 
long axis of the woman 's body ; it always lies in the long axis 
of the uterus, whether this be horizontal or vertical. It may 
lie obliquely if there exist a tumor or thickening in the uterine 
wall, or if the uterine cavity be irregular in its outlines. 

How many different presentations are liable to be met 
in obstetric practice? What are they? 

There are three presentations of the fetal body, viz., the 
cephalic or head, the pelvic, and the transverse or trunk. 
The cephalic presentations include the vertex, face, bregma 
or anterior fontanel, broiv, ear, and parietal eminence. The 
pelvic presentations include the breech, knee, and foot. 

How is a vertex presentation recognized by palpation? 

Examination of the abdomen shows the hard cephalic ex- 
tremity of the child at the pelvic brim; vaginal examination 
reveals the depressed occiput and smaller fontanel at one 
extremity of a pelvic diameter, while the sagittal suture 
extends obliquely from them in the line of the diameter. 

Differentiate the positions of the fetus at term as deter= 
mined by external palpation. 

Cephalic or head presentations show the fetal ellipse lying 
longitudinally, with the fetal back to one or the other side 
and the hard cephalic extremity at the pelvic brim; fetal 
movements are felt high up on the abdominal surface. In 
pelvic presentations the conditions are reversed, the head 



OBSTETRICS AND GYNECOLOGY. 449 

above and the breech, below; the head may be freely moved, 
and the fetal movements are felt low down on the abdominal 
surface. In transverse presentations the long axis of the 
fetus lies at right angles to the long axis of the mother's body ; 
TDoth extremities of the fetal ellipse may be readily palpated. 

How may the knee be distinguished from the elbow 
when presenting? 

The knee is round and large, the elbow small and more 
angular; the elbow shows sharp bony processes to the sides 
and posterior; the popliteal space may be felt behind the 
knee; the arm may readily be brought down if the elbow is 
present; the leg is brought down with more difficulty. 

What is understood by the hygiene of pregnancy? In 
a case of pregnancy how is the health of the patient main= 
tained? 

By the hygiene of pregnancy is meant the management of 
the patient according to the rules of health. This includes 
regulation of the diet, clothing, exercise, bathing and douch- 
ing, and sexual intercourse; attention to the kidneys and 
other emunctories; the correction of constipation and proper 
occupation for the mind. 

Describe the proper management of the breasts of the 
mother before labor. 

Proper development of the nipples should be favored by 
judicious manipulation daily. The nipples should be kept 
clean by soap and water and a weak solution of sodium borate. 
If the breasts are painful they may be anointed at night with 
cocoa-butter or lanolin. 

What is the pathology of pregnancy? Name some of 
the diseases to which pregnancy predisposes. 

The pathology of pregnancy includes a study of the dis- 
eases to which a pregnant woman is exposed. The diseases 
she is most apt to develop are renal insufficiency, Bright 's 
disease, gingivitis, salivation, pica, indigestion, pernicious 
29 



450 OBSTETRICS AND GYNECOLOGY. 

vomiting, constipation, hemorrhoids, jaundice, appendicitis,, 
dyspnea, cardiac palpitation, hydremia, pernicious anemia, 
varicose veins, hemorrhage, uterine displacements, insanity,, 
neuralgias, and osteomalacia. 

To what form of morbus Brightii are pregnant women 
most liable? How would you diagnose and treat it? 

To acute nephritis, catarrhal or interstitial in nature. It 
is frequently so called when in reality the kidney of preg- 
nancy is meant. 

Give the etiology, symptoms and management, as best 
understood and practiced at present, of albuminuria of 
pregnancy. What is the prognosis? 

By the albuminuria or kidney of pregnancy is meant a. 
peculiar condition manifested by a certain proportion of 
pregnant women in which albumin appears in the urine in 
varying amounts, but which is unassociated with any grave 
organic change in the kidneys. The condition is one of hemic 
intoxication, the poisons probably originating in an imper- 
fect metabolism on the part of the liver. The poisons irritate 
the kidneys, producing an arteriole contraction, whereby the 
kidneys appear pale and anemic, and become inadequate to 
perform the work devolved upon them. The treatment of 
renal inadequacy consists in a careful supervision of the 
condition of the urine, and appropriate dietetic, hygienic and 
therapeutic regimen. Milk diet or light diet, large draughts 
of Poland or lithia water, diuretics, laxatives, alteratives, 
Basham's mixture, irrigation of the bowel with hot normal 
saline solutions, and the bromids and chloral hydrate consti- 
tute the treatment. If the disease progresses labor may have 
to be induced. The prognosis is always anxious. 

How would you measure the severity of interstitial 
nephritis in a pregnant woman, and how would you treat 
such a condition? 

By the early appearance of the symptoms, by the number 
and nature of the urinary casts, by the development of albu- 



OBSTETRICS AND GYNECOLOGY. 451 

minuric retinitis, and by the rapidly increasing edema. The 
disease requires an early evacuation of the uterine contents. 

What is the cause of difficult and painful urination in 
pregnancy? 

When present this generally results from uterine displac- 
ment backward, the cervix tilting up against the base of the 
bladder and interfering with micturition. 

How do uterine displacements originate, and how do 
they influence conception and pregnancy? 

Uterine displacements are generally the result of previous 
labors, the floor being lacerated and the uterus remaining 
subinvoluted and heavy. Such an organ falls back into the 
hollow of the sacrum. Anteflexion of the uterus may result 
from a ventrofixation. Any fixed displacement is apt to pre- 
vent conception by rendering the ingress of the spermatozoids 
impossible, and if pregnancy results and the displacement 
persists, abortion is apt to occur spontaneously. 

What uterine displacement is especially liable to inter- 
rupt pregnancy, and what should be done to prevent it? 

Eetrodisplacement. Such a displaced uterus should be 
replaced at once, and a pessary introduced and retained until 
the fundus rises above the sacral promontory (fourth month) ; 
it may then be withdrawn. 

What treatment would you advise for a case of con= 
tinued menstruation during pregnancy? 

Such a condition indicates failure of union between the 
decidua vera and decidua reflexa. The patient should be 
kept quiet, especially at the menstrual epochs. No local 
treatment is indicated as a rule. If the hemorrhage becomes 
profuse the treatment of threatened abortion must be insti- 
tuted. 

Name the diseases of the endometrium, and state their 
effects in pregnancy. 

Inflammation {endometritis), acute or chronic, will tend 



452 OBSTETRICS AND GYNECOLOGY. 

to produce abortion. Chronic endometritis, especially if 
syphilitic in origin, is probably the most common cause of 
abortion. Atrophy of the decidua (hypertrophied endome- 
trium) causes the ovum to drop in the uterine cavity, and 
may result in placenta prsevia. A catarrhal endometritis 
may cause an accumulation of fluid between the layers of the 
decidua, producing the condition known as hydrorrhea gravi- 
darum, or "false waters." Apoplexy of the decidua may 
destroy the ovum. Tumors may form in the decidua rarely ; 
if benign they are known as benign deciduomata; malignant 
deciduoma is rarely encountered. 

What diseases of the mother are liable to injure the 
fetus in utero? 

Syphilis, tuberculosis, rickets, the exanthemata, renal in- 
adequacy, puerperal eclampsia; any disease causing stagna- 
tion in the circulation, as chronic valvular disease and spas- 
modic maternal affections, as bronchitis, chorea and the like. 

Mention some of the principal causes of sterility in 
woman, and state how fertility may be promoted. 

Stenosis of the cervical canal from anteflexion, retrodis- 
placement of the uterus, cervical catarrh with profuse acrid 
leukorrhea, chronic salpingitis resulting in occlusion of the 
Fallopian tubes, and chronic endometritis. Rapid progressive 
dilatation of a stenosed canal, replacement of a displaced 
uterus, the local treatment of cervical catarrh and uterine 
disease will do much to restore a normal condition and pro- 
mote fertility. 

Define abortion, miscarriage, and premature labor. 

Abortion is the discharge of the ovum during the first tri- 
mester of pregniuicy. Miscarriage is the discharge of the 
embryo during the second trimester. Premature labor is the 
delivery of the fetus after the period of viability and before 
full term. 

What is the management of abortion, both preventive 



OBSTETRICS AND GYNECOLOGY. 453 

and curative? Give its causes, diagnosis, and indications 
for treatment. 

The causes of abortion are numerous. They include cer- 
tain morbid states of the ovum and fetus, as apoplexy of the 
ovum, disease of the umbilical vesicle, disease of the fetal 
membranes, malposition of the placenta, disease of the fetus, 
as syphilis and hydrocephalus, death of the fetus, certain 
paternal causes, as a diseased spermatozoid, certain maternal 
diseases, as the exanthemata, valvular heart-disease, renal 
inadequacy, convulsive disorders, as chorea and epilepsy,, 
malformations of the uterus, profound mental shock, and 
traumatism. 

The symptoms of abortion are sacral discomfort, steadily 
increasing hemorrhage, uterine contractions, and finally ex- 
pulsion of a part or the whole of the product of conception. 
The diagnosis may be made by a study of the symptoms, by 
the physicial signs, and by an examination of the discharged 
products. The preventive treatment consists in absolute 
quiet and rest in bed, lowering of the head, the administra- 
tion of nerve-sedatives, as sodium bromid, and the introduc- 
tion of an opium suppository. The curative treatment con- 
sists in vaginal and cervical tamponade to control bleeding, 
followed by emptying of the uterine contents. 

What are the premonitory symptoms of abortion? 

At the best these are vague and unreliable. They consist 
in a sense of discomfort or fulness in the pelvis, sacral pains, 
a feeling of malaise, a tendency to vesical tenesmus, chilly 
sensations, and beginning discharge of serum or blood from 
the uterus. 

What are the symptoms of threatened abortion? 

Pain, increasing hemorrhage, and opening of the uterine 
mouth. 

Describe the symptoms and give the management of an 
incomplete abortion. 

The body of the uterus will be large, soft and boggy; the 



454 OBSTETRIC 8 AND GYNECOLOGY. 

-cervical canal will be patulous; the finger introduced into 
the cavity of the uterus will detect clots, fragments of mem- 
brane and pieces of soft, pulpy, placental tissue ; the discharge 
will be dark, hemorrhagic and grumous, and there may or 
may not be a fetid odor. The treatment consists in the asep- 
tic removal of the uterine contents by means of the finger or 
placental forceps, followed by an intra-uterine douche of mer- 
curic chlorid, 1-4000, and the administration of small doses 
of ergot if the hemorrhage persist. 

What are the symptoms of an inevitable abortion? 

Steadily increasing hemorrhage and pain despite the pre- 
ventive treatment, and the presence of Tamier's sign, namely, 
obliteration of the angle of flexion between the upper and 
lower uterine segments by the descent of the detached ovum. 

What means should be employed to prevent threatened 
abortion during the first three months of pregnancy? 

The avoidance of over-exertion, the correction of uterine 
displacement, rest in bed at the menstrual epochs, the admin- 
istration of sodium bromid, viburnum prunifolium and other 
sedatives, and occasionally the use of an opium suppository. 

How should inevitable abortion be managed? 

A vaginal and intracervical tampon should be introduced 
and left in situ for 8 hours. On its removal the ovum will 
probably be found attached to it. If not, a second tampon 
may be introduced and retained for from 6 to 8 hours. If this 
fails to bring the ovum away the patient should be anesthe- 
tized and the product removed by the finger or the placental 
forceps. 

When and how should abortion be induced? 

The induction of abortion is indicated when maternal life 
is menaced by some grave pathologic state of the fetus or of 
the mother, as cystic disease of the chorion, acute hydramnios, 
large uterine or pelvic tumors, extreme pelvic contraction, 
pernicious vomiting, pernicious anemia, chronic nephritis 



OBSTETRICS AND GYNECOLOGY. 455 

and the like. The best method of inducing abortion" consists 
in rapid dilatation of the cervix after thorough asepsis of the 
vagina, with the immediate removal of the ovum by the finger 
and placental forceps. 

Is the production of premature labor ever justifiable? 
If so, when and how would you accomplish that object? 

The indications for the induction of premature labor in- 
clude all conditions menacing fetal or maternal life, as well 
as those pathologic states of either mother or child that will, 
if the pregnancy be allowed to continue to term, be productive 
of grave degrees of dystocia. These are, oversize or prema- 
ture ossification of the upper portion of the fetal skull, acute 
hydramnios occurring late in pregnancy, habitual death of 
the fetus during the last days or weeks of pregnancy, pelvic 
deformity, placenta praevia, pernicious anemia, pernicious 
vomiting, increasing albuminuria, eclampsia, grave valvular 
disease, advanced pulmonary tuberculosis, tumors in the pel- 
vic canal. The best method of inducing labor is the intro- 
duction of an aseptic rubber catheter into the uterus. Other 
methods include the use of Barnes' or Champetier de Ribes' 
bags, and rapid digital divulsion of the cervix with the per- 
formance of podalic version. 

Define and classify ectopic pregnancy. Give its causes, 
symptoms and treatment. 

Ectopic or extra-uterine pregnancy is a generic term mean- 
ing pregnancy at any point outside of the uterus. This 
includes tubal pregnancy, interstitial pregnancy, tubo-ovarian 
pregnancy, ovarian pregnancy , and primary and secondary 
abdominal pregnancy. The causes of this condition are un- 
known. The condition is generally encountered in women 
who are between 20 and 30 years of age, and who present a 
history of a protracted period of sterility following one or 
more pregnancies. It was formerly believed to be due to a 
salpingitis, but Sutton now states that it is more liable to 
occur in a healthy tube. Tubal diverticula may produce it. 



456 OBSTETRICS AND GYNECOLOGY. 

The symptoms are the presence of all the signs of early ges- 
tation, irregularity in the menstrual history, vaginal pulsa- 
tion, lancinating, cramp-like pains in the affected side, slight 
elevation of temperature, and lateral displacement of the 
uterus by a very sensitive mass. The treatment consists in 
immediate abdominal section and removal of the gestation-sac. 

What are some of the possible terminations of a tubal 
pregnancy? 

Tubal pregnancy may terminate in rupture, which is usual.. 
In a certain percentage of cases the embryo may die within 
the first few weeks of gestation ; this is known as the sponta- 
neous cure of extra-uterine pregnancy. Barely the condition 
may go to term. 

What are the symptoms of rupture in ectopic preg- 
nancy? What should be done when such rupture occurs? 

The symptoms of rupture are sudden and characteristic. 
They consist in exceedingly severe cramp-like pains in the 
iliac region of the affected side, associated with collapse and 
the symptoms of concealed hemorrhage, namely, extreme 
pallor of the surface, feeble running pulse, air-hunger, moist, 
clammy skin, coldness of the extremities, vomiting, and fre- 
quently coma. There is an increased discharge from the 
vagina ; large masses of decidual tissue are usually discharged 
at this time. Immediate laparotomy should be performed. 

What preliminary preparations would you suggest for 
a case of labor? 

The thorough disinfection of the physician, nurse and 
patient according to the accepted methods, the opening of the 
patient's bowels by means of a rectal enema, the proper 
preparation of the patient's clothing and bed. The nurse 
should have on hand the various drugs and instruments, as 
well as hot water, for whatever obstetric ' operation may be 
required. 

What is labor? 

Labor is that natural process by which a pregnant woman 



OBSTETRICS AND GYNECOLOGY. 457 

expels the product of conception at the full expiration of the 
period of pregnancy, 280 days after conception. 

Into what stages is labor divided, and where do these 
stages begin and end? 

There are three stages of labor. The first or stage of dila- 
tation begins with the first labor pain and continues until the 
os is fully dilated. The second stage or stage of expulsion 
extends from full dilatation until the delivery of the child 
is accomplished. The third stage or stage of the placenta 
extends from the delivery of the child until the expulsion of 
the after-birth. 

What are the prodromata of labor? 

The onset of labor is indicated from 2 to 4 weeks before by 
the phenomenon known as lightening. This is produced by 
the entrance of the child's head into the superior strait, and 
occurs 2 weeks before term in multiparas and 4 weeks before 
term in primiparae. The symptoms of beginning labor are 
pain, beginning dilatation of the os, and a bloody discharge 
known as the show. 

What is the diagnosis of false from true labor pains? 

False labor pains are annoying, colicky sensations occur- 
ring during the last 2 or 3 weeks of pregnancy, which usually 
depend upon constipation or pressure upon nerve-trunks. 
They are irregular in their location, and are not accompanied 
by dilatation of the os. True labor pains are involuntary 
and painful contractions of the uterine muscles occurring 
intermittently and with increasing severity at decreasing in- 
tervals. They are usually felt in the small of the back, and 
from this point pass around the abdomen. They may reverse 
this direction, and, commencing at the umbilicus, pass back- 
ward to the sacrum. They are cumulative in nature, of 
unequal intensity, and last from one-half to one minute. 
They result in dilatation of the os. 



458 OBSTETRICS AND GYNECOLOGY. 

Give the character, situation and cause of the pains 
during the first and second stages of labor. 

During the first stage of labor the pains are as described in 
the foregoing answer. They result from squeezing of the 
nerve-fibrils by the contracting of the uterine muscles. They 
are colicky in nature, and aside from opening the os do not 
favor the expulsion of the child. In the second stage of labor 
the character of the pains changes. They become bearing- 
down or expulsive in nature. The pain now is due to pres- 
sure upon the soft tissues of the lower parturient canal, as 
well as to the pressure upon the nerve-fibrils above. 

What means are employed to stimulate ineffective 
uterine contractions? 

The administration of quinin in large doses, the application 
of a firm abdominal binder, keeping the woman upon her feet, 
and the taking of a small amount of food may all result in an 
increase of the uterine pain. Ergot or its substitutes should 
not be administered. 

What is meant by the mechanism of labor? 

By the mechanism of labor is meant the manner in which 
the fetus and secundines pass through the parturient canal 
and are expelled. 

Define and differentiate position, presentation and 
rotation. 

By position is meant: 1. The varying relationship borne 
by the most prominent point of the presenting part of the 
fetus to the cardinal points of the pelvis. 2. The relationship 
existing between the long axis of the fetus and that of the 
maternal body. 

By presentation is meant that portion of the fetal body 
which is detected by the examining finger introduced to the 
center of the plane of the superior strait. 

By rotation is meant the turning of the presenting part 
from right to left or left to right after it has struck the pelvic 
floor, so that it comes to present under the pubic symphysis. 



OBSTETRICS AND GYNECOLOGY. 459 

External rotation is a return of the presenting part to the 
side from which it comes after it has been delivered through 
the vulvar orifice. 

Give the normal vertex presentations in the order of 
their frequency. 

1. Left occipitoanterior, L. 0. A. ; 2. Right occipito-pos- 
terior, R. 0. P. ; 3. Right occipitoanterior, R. 0. A. ; 4. Left 
■occipito-posterior, L. 0. P. 

What is the most common presentation and which the 
most frequent position of the presenting part in normal 
labor? Give the average duration of a natural labor. 

The most common fetal presentation is the occipital or 
vertex; the most frequent position is the left occipitoanterior, 
L. 0. A. The average duration of labor in a primipara is 
from 12 to 15 hours ; in a multipara from 8 to 10 hours. 

Give the formation of the caput succedaneum. Where 
does the caput succedaneum appear in the third position? 

The caput succedaneum or " accessory head" is the tumor 
situated upon the presenting part of the fetus. It is formed 
by a serosanguineous infiltration of the connective tissue of 
the part. It is due to an edema of the part that is not com- 
pressed by the maternal structures. In the third position 
of the vertex, R. 0. P., the caput appears on the left parietal 
eminence. 

Describe the mechanism of labor in L. O. A. presen= 
tation. 

Adaptation of the fetal presentation to the pelvic strait. 
It consists of three steps, namely, preliminary flexion and 
moulding occurring with the phenomenon of lightening; fur- 
ther flexion and moulding occurring with the first labor pains ; 
and Naegele 's obliquity, or lateral inclination of the fetal head 
toward the maternal sacrum, the right parietal bone present- 
ing. The birth-canal is next prepared by being dilated by 
means of the bag of waters. The presentation next descends 
to the pelvic floor, the occiput resting on the floor. Internal 



460 OBSTETRICS AND GYNECOLOGY. 

anterior rotation of the occiput from left to right now occurs,, 
the occiput resting beneath the symphysis pubis. Birth of 
the head by a process of extension follows, the perineum 
retracting over the face, which appears first at the forehead 
and eyes and finally at the chin. Restitution or untwisting 
of the neck is then followed by external rotation of the head, 
which becomes transverse, with the occiput to the left side. 
The birth of the shoulders follows, the anterior or right shoul- 
der rotating from right to left; the rest of the trunk is then 
rapidly expelled. 

Describe the mechanism of labor in the L. O. P. position. 

The steps of the mechanism are the same as in the foregoing 
except that the head has further to rotate in order to reach 
the symphysis, and this excessive rotation requires a rotation 
of the shoulders at the superior strait from the right into the 
left oblique diameter, the anterior shoulder rotating from 
left to right. After restitution this shoulder rotates back 
again to the middle line from right to left. The rest of the 
mechanism is as in the L. 0. A. presentations. 

Name and describe the various forms of head=presenta- 
tion, with the management appropriate to each. 

The vertex presentation is most common; its management 
is that of an ordinary case of labor. Brow and face presen- 
tations are always abnormal, and will be described further 
on. Presentation of the bregma is the so-called "military posi- 
tion" of the fetus, the head being midway between flexion and 
extension, and set squarely on the shoulders. The large 
occipi to-frontal diameter of the fetal skull (11% cm.) pre- 
sents. This presentation must be converted into an occipital 
presentation in order to permit labor to proceed. Ear pre- 
sentation is a laterally deviated vertex presentation, and can 
generally be corrected manually or by altering the position 
of the patient. 

Give the face and breech presentations of the fetus. 

The face presentations are: 1. Left mento-anterior, L. M. 



OBSTETRICS AND GYNECOLOGY. 461 

A. ; 2. Right mento-anterior, R. M. A. ; 3. Right mentopos- 
terior, R. M. P.; 4. Left mento-posterior, L. M. P. The 
breech presentations are : 1. Left sacro-anterior, L. S. A. ; 2. 
Right sacro-anterior, R. S. A.; 3. Right sacro-posterior, 
R. S. P. ; 4. Left sacro-posterior, L. S. P. 

Give the causes of cephalic presentations, and state why 
vertex presentations are favorable. 

The causes of cephalic presentation are: 1. The peculiar 
shape of the uterus and of the fetal ellipse, the smaller ex- 
tremity of the fetal ellipse accommodating itself to the smaller 
portion of the uterine cavity; 2. The fetal center of gravity 
lies near the head, which becomes the dependent portion. 

How would you know a head=presentation? How a 
breech presentation? How a transverse presentation? 

In cephalic presentations palpation externally reveals the 
hard fetal skull at the superior strait; vaginal examination 
will reveal the dome-like projection of the brow or the vertex, 
or the features of the face. In breech presentations, if the 
membranes have broken, there will be a discharge of meco- 
nium; palpation will also show the soft pelvic structures, 
while externally the head can be felt at the upper portion of 
the abdominal wall. In transverse presentation the long axis 
of the fetus lies at right angles to the long axis of the maternal 
hody; vaginal examination is liable to show an arm or elbow 
presenting. 

Describe the mechanism of expulsion in natural labor. 

Expulsion is accomplished by the direct action of the 
uterine muscles upon the fetal body. The fetus is expelled 
because there is a decided diminution in the intra-uterine 
space, and the intra-uterine contents are propelled in the 
direction of least resistance, down the lower canal. 

What is the " bag of waters," its functions and manage= 
ment during labor? 

The bag of waters is the tough elastic membrane containing 



462 OBSTETRICS AND GYNECOLOGY. 

the liquor amnii, which can be felt protruding through the 
os during the process of dilatation. Its function in labor is 
to distend the cervical fibers, which it does by hydraulic pres- 
sure. It should never be ruptured in primiparous women, 
and in multiparas only after full dilatation of the os has been 
accomplished. 

State the causes of dilatation of the os and cervix uteri 
as related to labor. 

There 'are two causes of cervical dilatation in labor, namely, 
the wedge-like action of the bag of waters acting on the 
edematous cervical tissues, and the upward traction exerted 
by the longitudinal layer of muscular fibers in the uterine 
walls. 

Give a brief description of the three stages of labor. 

During the first stage of labor the pains occur at intervals 
of 30 to 5 minutes; they accomplish during this time the 
dilatation of the os. This stage may take from 2 to 20 hours, 
and the patient for most of this time may remain out of bed. 
In the second or expulsive stage, the patient lying in bed, the 
pains occur every y 2 to 5 minutes, and are assisted by volun- 
tary bearing-down on the part of the patient. This drives 
the presentation down upon the perineum, which bulges, and 
by its resistance directs the presentation to the vulvar orifice, 
through which it finally emerges. This stage consumes from 
30 minutes to 2 hours. The third stage, which seldom lasts 
over half an hour, consists in the expulsion of the placenta 
and membranes. 

What may cause premature rupture of the membrane? 
How may this rupture influence the progress and conduct 
of labor? 

Undue tenuity of the membranes may cause rupture to 
occur with the first labor pains. They may also be ruptured 
by the careless introduction of the finger during a pain. 
When the water escapes early the labor is said to be "dry."" 
This results in slow progress of the presenting part, and in. 



OBSTETRICS AND GYNECOLOGY. 463 

tedious dilatation of the os. The cervix is liable to extensive 
lacerations in such cases. 

Give the management of the second stage of labor. 

The patient lies upon the side toward which the fetal back 
is directed. In multipara?, if the membranes fail to rupture 
after full dilatation of the os, the obstetrician may break 
them with the finger-nail during the interval between two 
pains ; the water should be allowed to escape slowly. As the 
head descends to the floor the perineum must be guarded 
from laceration; on delivery of the head it should be sup- 
ported until the shoulders emerge, and as the child descends 
the hand should be placed upon the fundus uteri to maintain 
good contraction of the uterine muscle. 

Define the third stage of labor, and state how it should 
be managed. 

This is the period of placental expulsion. Immediately 
after the birth of the child the uterus contracts and the pla- 
centa sinks to the lower uterine segment. Here it lies for 15 
to 30 minutes, when a strong contraction occurs and the pla- 
centa is expelled. The accoucheur may, after ligation of the 
cord, hasten this delivery of the secundines by the applica- 
tion of Crede's method. If hemorrhage occurs or the uterus 
fails to contract, fluid extract of ergot may be administered, 
and a firm pad and binder should be applied. 

Describe the delivery of the placenta after the method 
of Crede. 

This consists in applying gentle rotatory friction to the 
fundus uteri until it is felt to harden under the influence of 
a uterine contraction ; the fundus is then grasped by the hand 
and compressed, while at the same time pressure is made 
downward and backward in the line of the axis of the par- 
turient canal. The placenta is rapidly expelled by this 
process. 



464 OBSTETRICS AND GYNECOLOGY. 

Describe the preparation of the bed, the woman, the 
physician and the nurse for a case of labor. 

The bed-linen should be clean, and on the side on which 
the woman lies the special temporary coverings should be 
laid. These include a large pad, a clean sheet, and a rubber 
blanket. These are removed after delivery is accomplished. 
The woman, as soon as labor begins, is given a full bath, and 
the external genitalia are cleansed with green soap and alco- 
hol. A clean garment is worn, and this is rolled up above 
the hips to prevent soiling. She is covered with a clean sheet. 
The physician and nurse disinfect themselves according to 
the accepted methods of aseptic surgery. 

Give the causes of separation of the placenta. State 
how the placenta normally presents at the os uteri. De= 
scribe the treatment. 

It is probable that the main cause of placental separation 
is a diminution in the area of placental attachment due to the 
excessive uterine contraction. Another view is that there 
occurs a partial central detachment of the placenta, with sub- 
sequent retroplacental hemorrhage. The separation does not 
occur until the beginning of the third stage of labor. The 
placenta once separated is expelled to the os uteri by passing 
through and inverting the membranes which drag after it ; 
the body of the placenta bulges forward in a spherical form. 
Duncan's theory is that the placenta slides down the lower 
uterine segment edgewise. The treatment of placental sepa- 
ration is expulsion by Crede's manipulation. 

What is the management of retained placenta? 

Retained placenta is quite distinct from adherent placenta. 
The former means a resting of the detached placenta in the 
temporarily paralyzed lower uterine segment. It is a harm- 
less condition, and is treated by Crede's expression. Adhe- 
rent placenta is one that is partially detached, but remains 
adherent at points to the original site of placental attach- 
ment. It causes post-partum hemorrhage, and requires imme- 
diate manual extraction. 



OBSTETRICS AND GYNECOLOGY. 465 

How should the first examination be made at the bed» 
side of a woman in labor? 

The object of the examination is to determine the position 
and presentation of the child, its condition, the progress of 
the labor, the size of the maternal pelvis and the condition 
of the soft structures of the parturient canal. The abdomen 
is first palpated and ausculted, the patient lying on her back. 
A vaginal examination is then made with the patient in the 
left lateral recumbent posture. The finger is retained against 
the membranes until the patient has had a pain in order that 
the efficiency of the pains may be determined. 

What is the perineum? How is it endangered in labor, 
and how should it be protected? 

The perineum is the pelvic floor, composed mainly of mus- 
cles and fibrous tissues. The main muscle is the levator ani, 
a large butterfly-shaped muscle, which affords the chief sup- 
port to the pelvic viscera. As the head descends it impinges 
on the perineum and stretches it; not infrequently serious 
lacerations result in consequence of too precipitate delivery, 
disproportion between the head and vulvar orifice, or imper- 
fections in the mechanism of labor. There are various means 
of protecting the floor in labor. The head may be retarded 
by Hold's method, which consists in pressing the thumb 
against the occiput above and the index and middle fingers 
posteriorly against that portion of the head nearest the four- 
chet. The forceps may be applied and the movement of the 
head controlled. Bit gen's method of elevating the head and 
Olshausen's method of rectal expression are both valuable. 

What is episiotomy, and when is such interference indi= 
cated? 

Episiotomy is the making of a lateral incision of the vulva 

for the purpose of relieving vulvar and perineal tension. 

The incisions are made during the height of a pain upon the 

mucosa just within the vulvar cleft, and are from % to % 

30 



466 OBSTETRICS AND GYNECOLOGY. 

inch long and % inch deep. The operation should not be 
performed, simple perineal laceration being preferable. 

How should laceration of the perineum occurring during 
labor be treated? 

By immediate suturation if the tear be over % inch long. 
Simple tears of the f ourchet do not require suturing. Inter- 
nal tears of the sulci and tears involving the sphincter require 
immediate repair. If the tear is a simple median tear, and 
the tissues are severely bruised, a primary perineorrhaphy 
may not prove successful. 

Give the causes and treatment of laceration of the cer= 
vix uteri. 

Abortion or miscarriage when the cervix is still rigid; pre- 
cipitate delivery, especially if the woman be on her feet; 
oversize of the fetal parts; instrumental delivery, the head 
not yet having escaped from the uterus. If there is no hem- 
orrhage from the tear nothing should be done. If the circular 
artery has been cut a suture must be introduced at once. 

Give the rules for administering anesthetics in labor, 
stating when they are indicated. 

No anesthetic is required in a normal labor until the head 
is down on the perineum ; it is then well, if the pains be severe 
and the patient suffering unduly, to administer a few drops 
of ether or chloroform, not sufficient to arrest the uterine 
contraction, but enough to dull the pain. In all operative 
procedures full anesthesia will be required. In puerperal 
eclampsia during the convulsions chloroform should be ad- 
ministered; also in the spasms of major chorea- 
State the effects of anesthetics on the os uteri, cervix 
uteri, abdominal muscles, perineum and child. 

If the anesthesia be complete the cervix, os and perineum 
become relaxed ; all voluntary motion ceases, and the rigidity 
of the parts is overcome. A certain amount of fetal asphyxia 
results in profound maternal anesthesia. The labor is neces- 



OBSTETRICS AND GYNECOLOGY. 467 

sarily protracted, since the uterine contractions are largely 
or completely abolished. 

What are the antiseptic measures to be employed in the 
care of a case of labor? Define the terms asepsis and 
antisepsis, and give their proper application in the lying=in 
chamber. 

Asepsis means absence of septic matter, or freedom from 
infection. Antisepsis means exclusion of the germs that 
cause putrefaction or infection. As applied to labor it means 
the thorough cleanliness of the patient, bed, room, water, 
instruments, dressings, clothing, physician and nurse. It 
includes the use of antiseptic agents, such as carbolic acid, 
mercuric chlorid, creolin, lysol and the like. It includes for 
some the use of rubber gloves and the exclusion, as far as 
possible, of the vaginal examination. 

What would contraindicate the use of anesthetics in 
labor? 

Grave renal disease and any severe pulmonary affection. 

What preliminary preparations are necessary for the 
safe conduct of labor? 

The nurse should have on hand aseptic dressings, anti- 
septic agents, sterile water, hemostatic remedies, as gauze,, 
ergotin and hot water, bichlorid tablets, creolin or lysol, chlo- 
roform to meet an eclamptic seizure, obstetric forceps, and 
whatever else may be needed to meet any emergency. 

What are the dangers to the mother during the second 
stage of labor, and how can they be minimized? 

The dangers are uterine inertia, with prolonged pressure 
of the fetal head upon the maternal tissues, which might 
result in a slough; the onset of eclampsia; rupture of the 
uterus from obstruction; laceration of the cervix and peri- 
neum from disproportion between the head and vulvar orifice, 
or from precipitate labor; hemorrhage from premature sepa- 



468 OBSTETRICS AND GYNECOLOGY. 

ration of the placenta; apoplexy or syncope; rupture of 
varicose veins. 

What are the uses and dangers of ergot in obstetric 
practice? 

The routine administration of ergot' is to be condemned. 
It should be employed in uterine exhaustion and inertia dur- 
ing the late second and third stages of labor and after delivery 
has been completed. If given too early it may cause an 
irregular hour-glass contraction of the uterus, with retention 
of placenta, clots, membranes or debris. It has a retarding 
influence upon the development of the milk. It may, if given 
early, cause fetal asphyxia from tetanic uterine contraction. 
It also increases the danger of cervical and perineal lacer- 
ations. 

State under what circumstances the vaginal douche may 
be employed before, during, and after labor. Give the 
technic. 

Unless the patient be already infected, as from gonorrhea, 
a, vaginal douche .should not be given before labor, in order 
to avoid introduction of germs with the nozzle of the syringe 
and the washing away of the normal vaginal secretion. Dur- 
ing labor a douche is given only when there is a profuse 
gonorrheal discharge or when some obstetric operation is 
about to be performed. After normal labor no douche is 
required as a rule. If there has been much manipulation of 
the parts, or version or other operation has been performed, 
one douche should be given, mercuric chlorid 1-2000 being 
employed. If the lochia become offensive at any time vaginal 
douching should be begun at once. 

Describe the duties of the accoucheur during normal 
labor. 

He is to act simply as an overseer. Examination should 
not be made too freely; only often enough to note a satisfac- 
tory progress of the labor. During the second stage he should 
regulate the descent of the head, institute measures to pre- 



OBSTETRICS AND GYNECOLOGY. 469 

serve the perineum, support the head after delivery until the 
shoulders are born, attend to the mouth and eyes of the child, 
ligate the cord, and superintend the discharge of the secun- 
dines. He should see that uterine relaxation does not occur, 
and after the patient has been cleaned he should apply the 
pad and binder. He should see that the proper toilet for 
the baby is made. 

What care does the mother require after labor? 

She should be covered to prevent chilling and shock. She 
should be cleaned as soon as possible, and the proper occlu- 
sive dressing of the vulva applied and secured to the abdom- 
inal binder. The bed should be made, and clean clothing for 
it and the. patient be provided. If there is a tendency to 
relaxation of the uterus ergot should be administered. The 
head should be kept low and visitors excluded. The visits 
should be made at suitable intervals, and careful watch kept 
of the pulse, temperature, discharge and breasts. The pro- 
gress of involution should be noted. The bowels should be 
opened by the third day and the proper diet instituted. 

What is involution? Define subinvolution. How long 
a time is usually required for involution, how may it be 
promoted, and what causes may operate to delay or pre= 
vent it? 

By involution, as applied to the uterus, is meant the retro- 
gressive change undergone by that organ after parturition, 
by which it returns to its normal weight and condition. It 
is brought about mainly by a rapid fatty degeneration of the 
hypertrophied muscular tissue. It is completed in six weeks, 
and is favored by rest in bed, the repair of cervical and peri- 
neal lacerations, the prevention of uterine displacements, and 
the nursing of the child. It is delayed by early rising, 
bottle-feeding of the baby, neglect of the cervix, uterus and 
perineum, and an early resumption of household duties. 
Subinvolution is a failure of the uterus to return to its normal 
size. 



470 OBSTETRICS AND GYNECOLOGY. 

What are after=pains? State their cause and give the 
treatment. 

After-pains are irregular and painful contractions of the 
uterus produced by efforts on the part of that organ to expel 
clots or shreds of membrane; they indicate a partial relaxa- 
tion of the uterine tissue, and are more common in multipara. 
They are relieved by pressure, and are followed by the dis- 
charge of clots. The treatment consists in the administration 
of opiates and fluid extract of ergot, embrocations of chloro- 
form and belladonna liniments or a hypodermic injection of 
niorphin. 

What general directions should be observed in passing 
the catheter on a patient during the puerperal state? 

Absolute cleanliness of the meatus and vestibule, as well as 
of the catheter, to prevent cystitis. The parts should be 
bathed in mercuric chloricl 1-5000, and the patient should 
not be catheterized oftener than once in eight hours. 

What changes occur in the fetal circulation at birth? 

With the stopping of the feto-placental circulation there 
occurs a closure of the foramen ovale, the Eustachian valve 
atrophies, and the ductus venosus and ductus arteriosus close 
and atrophy; the pulmonary circulation increases at once 
and becomes as in the adult individual. 

What indications of premature birth can be determined 
in the infant? 

Undersize of the infant; the nails do not project over the 
finger-ends; there may be some lanugo present, and there is 
an excess of vernix caseosa; the face is senile and wrinkled, 
and the development of the limbs imperfect; there is a ten- 
dency to subnormal temperature. 

How soon after the birth of the child should the um- 
bilical cord be ligated, and describe your method of pro= 
cedure? How should the umbilicus be managed? 

The cord should be ligated only after the pulsations have 



OBSTETRICS AND GYNECOLOGY. 471 

entirely ceased. A small-sized tape should be used, and the 
cord tied about 2 inches from the umbilicus, a surgeon's knot 
being used. It may be necessary in very thick cords to 
"strip" the cord so as to remove the excess of Wharton's 
jelly. The stump and umbilicus should be thickly dusted 
with a powder of salicylic acid 1 part and starch 4 parts, and 
then covered with salicylated cotton, through which the cord 
is passed. The whole is then supported by the binder. 

Describe the care of the infant during the first 24 hours 
after birth. 

After the establishment of respiration and the severing 
of the cord the baby should be given a bath. The vernix 
caseosa must be removed by rubbing with sweet oil. Castile 
soap and warm water are used in cleansing, and care must 
be taken not to irritate the delicate skin by rubbing. Diapers 
must be changed hourly, and plenty of talcum powder dusted 
on the body to prevent chafing. The breast should be given 
the baby every four hours. In this way it learns to nurse, 
consumes the colostrum, whereby the meconium will be ex- 
pelled, and by reflex action causes firmer uterine contraction. 

Describe the immediate care of the new=born child when 
for any reason the mother cannot nurse it. Give the rules 
for artificial feeding. 

The new-born baby docs not need food for the first 24-36 
hours. It may be given a spoonful of water now and then, 
and if it seems hungry it may be given two or three spoonfuls 
of a mixture of condensed milk and water 1 part to 12. If 
it become necessary to feed the baby from the bottle the latter 
must be kept absolutely clean, and a milk-preparation of 
suitable strength should be given. Germs may be destroyed 
by Pasteurization. The preparation usually employed con- 
sists of condensed milk 1 part, boiled water 12 parts, cream 1 
part, and limewater 1 part. The baby should be fed every 2 
to 2y 2 hours during the first month. The nursing should 
consume from 15 to 20 minutes. 



472 OBSTETRICS AND GYNECOLOGY. 

What instructions should be given a primipara in re- 
gard to lactation? 

She should be instructed as to the frequency of nursing 
and care of the nipple. Every 2 to 2% hours by the clock is 
often enough for the feedings, and after the nursing the nip- 
ple should be bathed with warm water, thoroughly dried with 
a soft towel or lint, and anointed with sweet oil. The oil 
should be removed before the nipple is given to the infant 
at the next feeding. 

How soon after parturition should a woman menstruate? 

If she nurse her baby menstruation does not normally 
return until the ninth month. An early appearance of the 
menstrual flow usually indicates subinvolution of the uterus 
or cervical laceration. 

What is the puerperal state? 

The puerperal state or puerperium is the period following 
the delivery of the placenta, in which the processes of involu- 
tion are being carried on. It is characterized by rapid dimin- 
ution in the size of the uterus and vagina, decrease in the 
pelvic circulation, and lessening in the quantity of blood 
circulating in the body. 

What are the most frequent complications of the puer= 
peral period? 

Infection of the birth-canal, subinvolution, inflammation 
and abscess of the mammary gland, postpartum hemorrhage 
and constipation. . 

How should a case of labor be conducted to avoid puer= 
peral infection? What are the sources of septic infection 
in the puerperal state, and what would be the proper man= 
agement if infection should occur? 

Thorough asepsis of the woman, bed, surroundings, physi- 
cian and nurse, as already delineated, must be insisted upon. 
The hands of the physician and nurse, the water employed, 
and the instruments are the chief sources of danger. Should 



OBSTETRICS AND GYNECOLOGY. 473 

infection occur the vagina and uterus should be well douched 
with mercuric chlorid 1-2000-4000, and the uterus curetted 
with a dull curet to remove decaying fragments of placenta 
and membranes. This will generally be sufficient for local 
treatment. Internally, quinin, stimulants and strychnin 
must be administered. The graver forms of puerperal sep- 
sis require special courses of treatment. 

Describe the proper method of delivering an adherent 
placenta at term. 

The hand, which should be aseptic, must be immediately 
introduced into the uterine cavity to the fundus, following 
the umbilical cord to the placental site. The placenta should 
be grasped and the adherent portions pinched off rapidly. 
The external hand grasps the uterine fundus and the internal 
hand is expelled by the uterine contractions. A hot douche, 
intra-uterine, must then be given, and ergot administered by 
the mouth or hypodermically. Firm uterine contractions 
must be secured before the patient is left. 

How would you treat asphyxia in the new=born child? 
What are its causes and symptoms? 

The causes of asphyxia neonatorum are syphilitic stenosis 
of the vessels of the cord and placenta, abnormality of the 
heart or great vessels, early separation of the placenta, undue 
pressure upon the cord, sudden maternal death, renal inade- 
quacy, and grave maternal lung-disease. The condition 
appears in two forms, viz., asphyxia livida and asphyxia 
pallida. In the former the baby is blue or livid, there are 
irregular gasping efforts, the heart-beats are strong, and the 
reflexes are preserved. In the pale variety respiration is 
altogether abolished, the surface is pale, the heart-sounds are 
weak and irregular, and the reflexes are absent. The treat- 
ment consists in early ligation of the cord, suspension of the 
child by the feet, cleansing of the throat and mouth by the 
finger, slapping the back and buttocks, the pouring of water 
or ether on the epigastrium, and in the pronounced cases the 



474 OBSTETRICS AND GYNECOLOGY. 

employment of some form of artificial respiration, notably 
the methods of Dew, Laborcle, Schultze and Prochownick. 
Occasionally mouth-to-mouth insufflation, catheterization of 
the larynx, or tracheotomy may be required. 

Describe a method of resuscitation of the new=born. 

Deiv's method is excellent. The infant is grasped in the 
left hand in such a manner that the neck rests between the 
thumb and forefinger and the head hangs over in the position 
of full extension; the upper portion of the back rests in the 
palm of the hand, while the remaining fingers are inserted 
into the left axilla. The knees are grasped by the right hand, 
the right knee resting between the thumb and forefinger, the 
left knee between the index and middle fingers, and the thighs 
in the palm of the hand. The right hand depresses the body 
to favor inspiration, while to secure expiration the movement 
is reversed and the child doubled upon itself. 

What are the results of subinvolution of the uterus, and 
what is its treatment? 

Subinvolution of the uterus, if not corrected, results in a 
chronic endometritis, retrodisplacement and subsequent pro- 
lapse of the uterus from increased specific gravity, and the 
development of a chronic invalidism. The treatment consists 
in the retention of the uterus in its normal position by means 
of a pessary, curettage of the uterus, suturation of all cer- 
vical and perineal lacerations, and the administration of 
tonics, ergot and thyroid extract. 

How would you recognize retention of urine during 
labor and how after labor? Minutely describe the treat= 
ment that should be employed in each case. 

Retention of urine during labor is exceedingly uncommon. 
It might result from an uncorrected retrodisplacement of the 
uterus that has gone on to sacculation. In such a case, if 
catheterization of the bladder by the prostatic catheter fails, 
surprapubic puncture of the bladder would be required. Re- 
tention of urine after labor is not uncommon. It is charac- 



OBSTETRICS AND GYNECOLOGY. 475 

terized by inability on the part of the patient to urinate, 
severe pain in the bladder, and the development of a cystic 
tumor over the symphysis, which presents dulness on percus- 
sion. The treatment consists in aseptic catheterization, with 
withdrawal of one-half to three-fourths of the vesical con- 
tents, in order to avoid syncope. 

Describe the technic of intrauterine irrigation and state 
when its employment is justifiable. 

Intra-uterine irrigation is required only after some intra- 
uterine manipulation, as the performance of version, manual 
extraction of the placenta, or high forceps application, or in 
case puerperal sepsis has developed. The technic consists in 
antiseptic douching of the vagina and vulva, followed by the 
introduction to the uterine fundus of the two-Avay catheter. 
Mercuric chlorid 1-4000, creolin, lysol or sterile water may 
be employed. The douching may be resorted to once, twice 
or three times daily, according to the gravity of the patient's 
condition. 

Mention the pathogenic bacteria that invade the vagina, 
and state how the vagina is normally protected from them. 

A number of pathogenic germs have been discovered in the 
vagina. The most common are the streptococcus pyogenes, 
staphylococcus pyogenes aureus, staphylococcus pyogenes al- 
bus, bacterium coli commune, bacillus pyocyaneus, bacillus 
pyogenes fcetidus and others. There normally exist in the 
vagina a large number of long rod bacilli known as Doder- 
lein's bacilli. These secrete an acid environment which de- 
stroys pathogenic germs. 

Define puerperal sepsis, and state how to prevent it and 
how to overcome it. What is auto=infection? 

Puerperal sepsis is the infection of the puerperal woman 
by pathogenic germs. It may be prevented by careful atten- 
tion to the laws of asepsis and antisepsis. If septic infection 
developed it should be combated in the manner already de- 



476 OBSTETRICS AND GYNECOLOGY. 

scribed. Auto-infection of the puerperal woman is a rare 
form of sepsis, in which the germs are already in her system 
before the onset of labor, and become active immediately 
after parturition. 

State the causes, pathology, symptoms, treatment and 
sequelae of puerperal phlebitis. 

Puerperal phlebitis is a rare form of puerperal sepsis 
originating in the sinuses of the uterus. The germs invade 
the clots in the mouths of the sinuses; these quickly liquefy, 
and give rise to hemorrhages and to emboli, which are carried 
to remote portions of the body. This may result in instant 
death or in pyemia, with septic pneumonia, paralysis and 
other serious consequences. The treatment consists in the 
general treatment of puerperal sepsis, with avoidance of all 
local interference other than the introduction of a gauze tam- 
pon to control the hemorrhage. 

How would you diagnose puerperal metritis, and what 
methods would you employ in its treatment? 

Puerperal metritis is a late septic inflammation of the 
uterine muscle. It is characterized by an offensive lochial 
discharge, which contains fragments of necrotic tissue and 
detached portions of muscular fibers that have sloughed from 
the uterine wall. The uterus is large, soft, boggy and sensi- 
tive. There is danger of perforation of the uterine walls and 
the development of general peritonitis. Uterine phlebitis 
may also develop, with a resulting general pyemia. The 
treatment consists in hysterectomy performed with thorough 
asepsis. 

Define hysterectomy, and state when it is applicable in 
obstetric complications. 

Hysterectomy is excision of the uterus. It is indicated in 
puerperal metritis, extensive involvement of the broad liga- 
ments, and when tubal and ovarian infection is associated 
with profuse hemorrhage from the uterus. 



OBSTETRICS AND GYNECOLOGY. 477 

What is phlegmasia alba dolens? Give the varieties, 
symptoms and treatment. 

Phlegmasia alba dolens or "milky leg" is a peculiar late 
manifestation of puerperal sepsis, in which there occurs a 
thrombosis of the iliac or femoral veins on one side, usually 
the left, with an immense edema of the affected limb, which 
presents a characteristic white or milky appearance. In the 
phlcbitic or thrombotic form the edema first appears below 
at the ankle, the disease occurring as a sequel of uterine 
phlebitis, coagula being carried from the placental site into 
the hypogastric veins. In the cellulitic form the disease 
occurs as a result of a direct extension of an inflammatory 
process from the uterus through the broad ligament ana pelvic 
cellular tissue, the exudate occluding the iliac veins. The 
symptoms are pains in the affected limb along the course of 
the femoral vein, rapid pulse, elevation of temperature, cramp- 
like pains in the calf, edema, and extreme pallor of the limb, 
or, in a certain proportion of the cases, bluing of the leg; 
abscess or gangrene may follow. The treatment consists in 
the administration of stimulants and tonics, disinfection of 
the birth-canal, gentle laxatives, and immobilization of the 
limb, which should be elevated and kept warm. Anodyne 
poultices, and later ichthyol and belladonna ointments, may 
be applied. Abscesses should be opened, and if gangrene 
occurs amputation is necessary. 

What is postpartum hemorrhage? State the causes and 
varieties, and give the treatment, including prophylaxis. 

Postpartum hemorrhage or "flooding" is hemorrhage occur- 
ring at any time during the 24 hours after parturition. It 
may be primary, at the time of delivery, or secondary , when 
it occurs after contraction of the uterus has been secured. 
Its causes are retention of placental debris, adherent pla- 
centa, uterine inertia, or severe laceration of the lower birth- 
canal. The symptoms are free escape of blood, pallor, run- 
ning pulse, restlessness and coma, The prophylactic treatment 
includes the use of strychnin and tonics during the last 



478 OBSTETRICS AND GYNECOLOGY. 

trimester of pregnancy, and at the time of labor the avoidance 
of extreme exhaustion, and if the uterus be atonic the admin- 
istration of a dram of ergot as soon as the head is born. The 
active treatment consists in the immediate removal of all clots 
and debris, the application of Crede's manipulation, the 
hypodermic injection of ergot or ergotin, the intra-uterine 
injection of hot water, or the introduction of a large tampon 
of iodoform or sterile gauze. Herman's method of continual 
manual compression of the uterus and compression of the 
abdominal aorta may be tried in extreme cases. Traction on 
the cervix with volsella-forceps will often control the bleed- 
ing. Bleeding from the lower birth-canal must be controlled 
by the introduction of sutures. 

What is a tampon? How is it made and when is it 
properly used? What precautions are to be observed in 
its use? 

A tampon is a plug of cotton, gauze, wool or oakum used 
to stop some canal or compress a bleeding surface. It may 
be made by passing a string around a portion of the substance 
used, or it may consist of a long strip of material packed 
in firmly. It is indicated in obstetrics in excessive hemor- 
rhage, as from placenta praevia, relaxation of the uterus, or 
lacerations of the lower birth-canal. Care must be taken to 
see that the material used is thoroughly aseptic, and that the 
cervix and vagina are not so distended as to give entrance to 
air, whereby air-embolism may be induced. 

Differentiate eutocia and dystocia. Mention important 
varieties of the latter. 

Eutocia is normal or easy labor ; dystocia is abnormal, diffi- 
cult or painful labor. Dystocia may consist in precipitate, 
retarded or obstructed labor, or labor complicated by fetal 
or maternal accidents, or by gross fetal or maternal disease. 
This includes hydrocephalus, malpositions and malpresenta- 
tions of the fetus, eclampsia, rupture of the uterus, prolapse 
of the cord, placenta praevia. premature separation of the 



OBSTETRICS AND GYNECOLOGY. 479 

placenta, contracted pelvis, and various other conditions on 
the part of the fetus and mother. 

Give the causes of dystocia in the uterus, vagina, pelvis, 
and vulva. 

In the uterus as causes of dystocia may be mentioned the 
presence of tumors, double uterus, abnormal placental attach- 
ment, rupture of the uterus, and malpresentations of the 
fetus. In the vagina, septa, stenosis, and tumors; in the 
pelvis the various forms of contraction and bony and carti- 
laginous tumors ; in the vulva, hematomata, stenosis or atresia, 
imperforate hymen and tumors. 

Describe the difficulties which arise during labor from 
malposition of the fetal head. 

If the head lie transversely in the superior strait it will 
become partially extended, and cause larger diameters of the 
fetal skull to engage than in vertex presentations. This will 
cause prolongation or absolute blocking of the labor. Exces- 
sive moulding and disfiguring of the fetal presentation will 
follow; forceps or version may be necessitated. If the face 
or brow present, labor may become impossible. 

How would you diagnose and manage a case of occipito= 
posterior presentation? 

In this case the vertex may be directed to the right or to 
the left sacro-iliac synchondrosis, and the sagittal suture will 
lie in the right or left oblique diameter respectively. The 
R. 0. P. is the most common of the occipito-posterior presen- 
tations. The case must be treated by laying the woman upon 
the side toward which the fetal back is directed in order to 
secure full flexion of the head, and thereby prevent backward 
rotation of the occiput. A firm binder should be applied, 
and quinin must be administered and delivery accomplished. 
As the head rotates anteriorly, the instruments must be with- 
drawn and reapplied in the new oblique diameter. 



480 OBSTETRICS AND GYNECOLOGY. 

How would you diagnose and deliver an occiput in the 
hollow of the sacrum? 

In this case the small fontanel will be felt in the median 
line posteriorly and the large fontanel high up anteriorly. 
The ears may be palpated to either side in the transverse diam- 
eter. Labor will be blocked. Forceps must be applied, and 
as traction is made the handles must be elevated in order to 
overflex the head. When the occiput begins to greatly dis- 
tend the perineum and the brow comes under the symphysis, 
the handles must be carried downward, and the head delivered 
with the face emerging from under the symphysis. 

Describe in detail the proper procedure when the head 
is movable above the brim of the pelvis but does not 
engage. 

There is probably some degree of pelvic flattening present. 
If so the head will lie transversely. Axis-traction forceps 
should be applied and the head made to engage. If this be 
impossible, and the contraction of the pelvis is not too great, 
podalic version is indicated. In more extreme degrees of 
contraction Cesarean section must be performed. 

Give the frequency, causes, diagnosis, prognosis, treat= 
ment and dangers to the fetus in pelvic presentations. 

Pelvic presentations of the fetus occur in about 3 per cent, 
of all cases of labor. The causes of breech presentations are 
reserval of the shape of the fetus or of the uterine cavity, 
hydrocephalus, fibroid tumors of the uterus, prematurity of 
the fetus, hydramnios, fetal monstrosities, and multiple preg- 
nancy. In these cases the fetal head is freely movable and 
high up in the abdominal cavity; the fetal heart-sounds will 
be heard above the umbilicus and to either side. Vaginal 
examination shows an absence of a hard and protuberant pre- 
sentation ; the presentation is high up, and the bag of waters 
long and finger-like. If the membranes have ruptured a dis- 
charge of meconium will be noted. The prognosis is serious 
for the fetus. Thirty per cent, of these babies perish from 



OBSTETRICS AND GYNECOLOGY. 481 

asphyxia or injury to the head and neck in delivery. The 
treatment consists in non-action until the birth of the umbili- 
cus ; then there must be speedy extraction of the after-coming 
head in order to avoid fetal death. 

Describe the management of an impacted breech pre= 
sentation. 

If the breech become impacted attempts may be made to 
decompose it by Goodell's method, viz., the dragging down of 
one leg, upon which traction is made. If this does not succeed 
axis-traction forceps may be applied over the pelvis; this is 
a very efficient method. Other methods consist in the use of 
a fillet around the waist and thighs, and in dead babies the 
blunt hook over one thigh. 

Give the frequency, causes, mechanism and treatment 
of face presentation, L. M. A. position. 

Face presentation occurs in about y 2 per cent, of all cases 
of labor. It results from anything which will prevent 
thorough flexion of the head, such as an enlarged thyroid or 
thymus gland or a prominent thorax, or anything that will 
disturb the relationship existing between the long axes of the 
body and head of the fetus, as dolichocephalus. The mech- 
anism consists in full extension and moulding, descent of the 
chin to the pelvic floor, anterior rotation to the symphysis 
under which it lodges, and birth of the head by a process of 
flexion; the shoulder and hip then rotate from the opposite 
side, and the rest of the mechanism is the same as in vertex 
presentations. If the chin be anterior the labor will prob- 
ably be easy, since small diameters present. If the head 
sticks, forceps may be applied and the chin drawn down, after 
which labor will proceed. 

Give the diagnosis of face presentation before and after 
rupture of the membranes. 

Before rupture of the membranes the presentation will be 
noted as high ; there is an absence of the dome-like projection 
of other head presentations; the features of the face may be 
31 



482 OBSTETRICS AND GYNECOLOGY. 

detected. After rupture of the membranes the examining 
finger can be introduced into the mouth, when, if the child 
be living, reflex closure of the gums will be noted. 

How may a face presentation be converted into a vertex 
presentation? 

If labor have not yet begun, Schatz's method of cephalic 
version, performed by external manipulation alone, may be 
attempted. With one hand firm pressure is exerted against 
the anterior portion of the fetal neck, while counter-pressure 
is made with the opposite hand upon the occiput ; at the same 
time an assistant pushes the breech in the direction in which 
the face is looking ; the head is thus flexed upon the body and 
the vertex caused to present. If labor has already begun, 
and the os is dilating, Baudelocque's method of cephalic ver- 
sion, the "ratchet method," may be attempted under anes- 
thesia. One hand is placed against the face, and while the 
thumb pushes the chin upward the fingers hook over the occi- 
put and drag it down; an assistant at the same time carries 
the breech over to the side toward which the face is directed. 

What is the mechanism of a mento=posterior position, 
and what the complications? 

A persistent merito-posterior position is an absolutely im- 
possible labor, and therefore there is no mechanism. For 
labor to advance the chin must strike the pelvic floor. The 
lateral height of the pelvis is 3% inches (9 cm.), while the 
length of the fetal neck is only 1% inches. The posterior 
height of the pelvis is 5 inches (12% cm.). In order for the 
chin to reach the floor in these cases it would be necessary for 
the thorax and occiput (I8V2 cm. or 7 inches) to enter the 
superior strait simultaneously. No diameter of this strait 
could accommodate such a bulk. The uterus becomes tetanic 
in action, the head and shoulders become impacted, the child 
perishes, and the mother is exposed to the danger of uterine 
rupture. 



OBSTETRICS AND GYNECOLOGY. 483 

How should forceps be applied in a case of face presen= 
tation? 

In the mento-occipital diameter, the chin being in apposition 
with the heel of the bladder ; the forceps should be used only 
as rotators in mento-posterior positions. 

How would you manage a brow presentation? 

A brow presentation is an absolutely impossible case of 
labor. The occipito-mental diameter of the fetal head, 13% 
cm., attempts to engage, but can find no accommodation in 
the superior strait. The treatment consists in the perform- 
ance of jcephalic version, bringing down the occiput and apply- 
ing forceps. If this be not possible, podalic version should 
be tried. In impacted cases with the child dead, craniotomy, 
with perforation through the bregma, becomes necessary. 

How would you treat a case of lateral presentation? 

Lateral presentations of the head, including the parietal 
eminence or the ear, should be treated by manual replace- 
ment, converting the presentation into a true vertex presen- 
tation. If this be impossible forceps may be applied or 
podalic version performed. 

Make a diagnosis of transverse presentation, and state 
how it should be managed. Give the frequency, causes, 
mechanism and management of such a case. 

A transverse, shoulder or trunk presentation occurs in about 
% per cent, of all cases of labor. The causes are oversize of 
the fetal head, overgrowth of the entire fetus, fetal mon- 
strosities, mobility of the fetus, hydramnios, multiple preg- 
nancy, uterine deformities, undue obliquity of the uterus, 
uterine and pelvic tumors, placenta praevia, and traumatism, 
such as falls or jars. There is no mechanism for such a case, 
the labor being absolutely impossible. The condition may be 
recognized readily by external palpation, the child lying at 
right angles to the long axis of the maternal body. Vaginal 
examination reveals a high position of the presentation, and 
the shoulder or elbow may be palpated through the mem- 



484 OBSTETRICS AND GYNECOLOGY. 

branes. There is but one thing to do in all transverse pre- 
sentations, namely, podalic version under full anesthesia. 

How should a hand presentation be managed? What 
course would you pursue if you found an arm projecting 
from the vulvar orifice? 

This would indicate a cross-birth. The arm should be left 
alone, and podalic version performed. A tape may be tied 
around the wrist in order to prevent extension of the extremity 
during the process of turning; if the tape be held taut the 
arm is carried in front of the face and descends with the 
shoulders. 

What are the causes of precipitate labor, what are its 
dangers, and what is the treatment? 

Precipitate labor may be caused by an excess in the expul- 
sive power of labor or a deficiency in the resistant powers. 
The dangers to the fetus are asphyxiation from rupture of 
the cord or premature detachment of the placenta and injury 
from a fall upon the floor or into a commode. The maternal 
dangers are hemorrhage, fatal syncope from sudden evacua- 
tion of the uterine contents, inversion of the uterus, laceration 
of the cervix or perineum, and post-partum hemorrhage. The 
treatment of precipitate labor consists in a retardation of the 
advancing presentation in order to avoid the foregoing acci- 
dents. When the head is on the floor short forceps may be 
applied and the progress of the head arrested. 

What are the causes of delay in labor (a) on the part of 
the mother; (b) on the part of the child? 

The maternal causes of delayed labor are uterine inertia 
and obstruction in the birth-canal from any cause. The fetal 
causes are malposition and malpresentation, oversize, hydro- 
cephalus, fetal syphilis, fetal ascites, and other diseases caus- 
ing overgrowth of organs or distension of cavities. 

State the dangers and symptoms of a prolonged labor. 

The symptoms of prolonged labor are those of uterine iner- 



OBSTETRICS AND GYNECOLOGY. 485 

tia (see below). The dangers are, for the fetus, fatal com- 
pression of the brain-centers and intra-uterine respiration, 
with inspiration of liquor amnii or other substances. The 
maternal dangers are pressure-necrosis, the development of 
sepsis, exhaustion and death, and post-partum hemorrhage. 

Give the causes, diagnosis and management of uterine 
inertia. 

Uterine inertia is that condition in which the uterine con- 
tractions are irregular, weak and ineffectual, not sufficing to 
induce dilatation of the os or expulsion of the fetus. The 
causes are idiosyncrasy, advanced age of the woman, multi- 
parity, emotion, temporary paralysis of the uterine muscles, 
as from over-distension, weakness of the muscle, and any cause 
preventing the hydraulic action of the liquor amnii. The 
symptoms are weak, infrequent and irregular contractions, 
slight suffering, and slow or no advance of the fetal presen- 
tation. In the first stage of labor quinin may be adminis- 
tered in large doses and a firm abdominal binder applied; 
strychnin during the last weeks of pregnancy has a tendency 
to increase the efficiency of the uterine contraction. In the 
second stage of labor forceps should be applied, and ergot 
must be used after the delivery of the child in large doses to 
prevent post-partum hemorrhage. 

What is the proper management of rigidity of the os 
uteri in labor? 

Rigidity of the cervix is common in elderly primiparse and 
in those suffering from uterine inertia; it may result from 
cicatrices and from cancerous involvement of the cervix. The 
treatment consists in the administration of large doses of 
chloral, hot vaginal douches, anesthesia, cocain to the cervix, 
digital divulsion, or incision. 

Give the diagnosis and treatment of hour=glass contrac= 
tion of the uterus. 

Hour-glass contraction of the uterus is an irregular con- 
traction of the uterus, usually occurring before the escape of 



486 OBSTETRICS AND GYNECOLOGY. 

the placenta, which is retained above the ring of Bandl. The 
latter appears to be in an abnormal state of contraction. 
Digital exploration traces the cord up to the contracted ring. 
Treatment consists in digital divulsion of the contracted por- 
tion, followed by removal of the placenta and antisepsis of 
the cavity. 

Give the causes, symptoms, diagnosis and prognosis of 
rupture of the uterus during labor, and state how such an 
accident should be managed. 

The exciting causes of uterine rupture during labor are 
some insuperable obstruction to the delivery of the child, 
misdirected or injudicious efforts at version, and tetanic ac- 
tion of the muscle of the upper uterine segment from the 
administration of ergot. The predisposing causes are dimin- 
ished tonicity of the uterine walls, undue prolongation of 
labor, fatty degeneration of the uterine muscle, or a previous 
operation upon the uterus. The site of the rupture is usually 
in the lower uterine segment. The symptoms are sudden 
acute lancinating pain, immediate collapse, signs of internal 
hemorrhage, an anxious expression, pallor, rapid running 
pulse, recession of the presenting part, the presence of two 
distinct tumors, and the ability to detect the rent by the 
examining finger. The prognosis is grave; the maternal 
mortality is 55 to 60 per cent. The treatment consists in 
immediate evacuation of the uterine contents, and if the tear 
has not completely perforated the uterus the patient may be 
watched carefully for the development of sepsis. In com- 
plete laceration an abdominal section must be performed and 
the tear sutured aseptically. 

Make a differential diagnosis of intrauterine and extra= 
uterine hemorrhage. 

In the former there will be noted either a free escape of 
blood per vaginam or a rapidly distending uterine body, asso- 
ciated with the symptoms of hemorrhage. In the latter the 
signs of concealed hemorrhage will be present, and vaginal 



OBSTETRICS AND GYNECOLOGY. 487 

examination will reveal the presence of a boggy mass in the 
abdominal cavity and in Douglass' cul-de-sac. 

Give the diagnosis, causes and treatment of pelvic 
hematocele. 

Pelvic hematocele results generally from rupture of an 
extra-uterine pregnancy. It may result from rupture of 
varicose veins in the broad ligament. It is recognized by the 
signs of concealed hemorrhage and a rapidly increasing boggy 
mass in Douglas' cul-de-sac. The only treatment is abdom- 
inal section and ligation of the bleeding point. 

Name three important forms of hemorrhage occurring 
in obstetric practice. 

Antepartum hemorrhage, or that occurring in the last tri- 
mester of pregnancy. This may be due to placenta prsevia 
or premature separation of the placenta. Intrapartum hem- 
orrhage is that occurring during the progress of labor, as in 
the case of uterine rupture or inversion of the uterus. Post- 
partum hemorrhage is that form occurring immediately after 
labor. 

What is placenta praevia? Name its causes, varieties, 
symptoms, dangers and management. 

Placenta prcevia is that condition in which the placenta is 
attached to the lower uterine segment, and presents in front 
of the fetus. It may be complete or central {placenta cen- 
tralis), lateral, marginal and parietal. The cause of placenta 
prasvia is unknown. It has been said to be due to uterine 
subinvolution, low fixation of the ovum, and downward 
growth of the decidua reflexa. There is but one symptom, 
namely, free and painless hemorrhage, occurring at decreas- 
ing intervals and in increasing quantity. The dangers are 
fetal and maternal death from asphyxia, hemorrhage, air- 
embolism, and septic infection. The treatment consists in 
rapid dilatation of the os and delivery of the fetus by version, 
or in 'the marginal form the application of the forceps and 



4:88 OBSTETRICS AND GYNECOLOGY. 

rapid engagement of the head. In the central variety the 
hand must be carried directly through the placenta. 

Mention two distinct methods of dilatation of the cervix 
uteri in obstetric practice. 

Edgar's method consists in bimanual stretching and par- 
alyzing of the cervical muscle. The index and middle fingers 
of both hands are introduced into the cervix, which is gradu- 
ally but forcibly stretched in various directions. Another 
method is the use of bags, such as Barnes' or those of Cham- 
petier de Ribes and Voorhees. 

What are the dangers of traction on the child and on 
the placenta? 

Traction on the cord may cause premature separation of 
the placenta. It may cause rupture of the cord or avulsion 
of the cord from the placenta, or it may result in inversion 
of the uterus. 

What is inversion of the uterus, what its causes and 
symptoms, and how is it recognized? 

By this term is meant a turning of the uterus inside out, 
either completely or in part. It may occur spontaneously, 
the uterine fundus or placental site being temporarily par- 
alyzed and sinking in; it may result from traction on the 
cord, the placenta not yet having separated ; or it may follow 
suction from close fitting of the detached placenta in the lower 
uterine segment and traction being made upon the cord. 
Other causes are vigorous Crede manipulations and violent 
bearing down on the part of the woman. The symptoms are 
acute pain, hemorrhage, shock, bearing down, and the appear- 
ance of a tumor in the vagina. This may be mistaken for a 
uterine polyp, but the surface of the latter will be covered 
with the normal uterine mucosa, while the inverted uterus 
will show decidual tissue and the site of the placental attach- 
ment ; the orifices of the Fallopian tubes may also be detected. 
The treatment of acute inversion consists in immediate re- 



OBSTETRICS AND GYNECOLOGY. 489 

placement, followed by the introduction of a strip of gauze 
to prevent recurrence. 

Give the causes, pathology, symptoms and prognosis of 
eclampsia gravidarum, and state the relative frequency 
in primiparae and multiparae. What is the treatment? 

Puerperal eclampsia or puerperal convulsion is a convul- 
sive or epileptiform seizure appearing suddenly in a woman 
prior to, during or shortly after labor, and characterized by 
tonic and then clonic convulsions of the muscles, with albu- 
minuria, coma and death. The great majority of cases occur 
in primiparae — about 75 per cent. Other causes are heredity, 
climatic influence, multiple pregnancy, extreme anemia, and 
nervous excitability, all acting as predisposing influences. 
The true cause is the presence in the blood of toxins, probably 
of hepatic origin, which cause a general arteriole contraction ; 
as a consequence there follows an anemia of the base of the 
brain and a corresponding cortical congestion. The symp- 
toms are fixing of the eyes, tonic contraction of the facial 
muscles (sardonic grin), lividity, rapid involvement of all 
the trunk muscles, distension of the superficial veins, and 
frothing at the mouth. The paroxysm lasts from % to 2 
minutes. It is followed by increasing coma and a rise of 
temperature. The urine becomes loaded with albumin. 
The prognosis is grave ; 30 per cent, of the women and 50 to 
74 per cent, of the children perish. The causes of maternal 
death are asphyxia, cerebral apoplexy, syncope, pulmonary 
edema, and exhaustion. The fetus dies of asphyxia. The 
prophylactic treatment is the treatment of the kidney of preg- 
nancy. During the attack chloroform must be administered. 
After the spasm, if the patient be plethoric, venesection to 
the amount of 20-25 ounces may be performed, followed by 
the introduction of normal saline solution into the tissues. 
Croton oil 1 to 3 drops, chloral hydrate 30 grains by the rec- 
tum, and veratrum viride 15 drops of the fluid extract hypo- 
dermically may be administered. A hot pack aids in the 
elimination of the poison. The uterus should be emptied as 
soon as possible in order to still further relieve the system. 



490 OBSTETRICS AND GYNECOLOGY. 

Give the danger signals of impending eclampsia. 

Rapidly lessening amount of urates in the urine; lessened 
urinary toxicity, the development of eye-symptoms, including 
muscse volitantes, scintillations and blindness, and neuralgic 
pains over the eyes, under the clavicles and in the epigastrium. 

In case eclampsia gravidarum appears before the end of 
the eighth month how should it be managed? 

By dilatation of the os and removal of the child by forceps 
or version. The course of treatment already indicated should 
be adopted. 

What are the varieties of puerperal convulsions, and 
how are they differentially diagnosed? 

A puerperal woman may suffer from various convulsive 
seizures, including the true puerperal eclampsia. She may 
have an anemia or an hysteric convulsion, or one due to ner- 
vous irritability. A true epileptic convulsion may occur, 
but this is not accompanied by albuminuria, has not the same 
prodromata nor the rise of temperature, and there is, as a rule, 
a definite history of previous attacks. Meningitis is accom- 
panied by vomiting, optic neuritis, opisthotonos, and a rise of 
temperature before the onset of the convulsions. 

When is curettage of the uterus justifiable in obstetric 
practice, and how should it be performed? 

Curettage is required whenever there has occurred a reten- 
tion of some of the products of conception either after abor- 
tion or labor. The best curet is the finger of the obstetrician, 
but if this will not answer the dull curet may be employed 
or the placental forceps, under thorough asepsis and anti- 
sepsis. In curetting the uterine cavity the walls should be 
scraped systematically and without great pressure. The 
dangers are hemorrhage and perforation. 

Define puerperal mania. Give its etiology, symptoms 
and treatment. 

Puerperal mania is the most common form of puerperal 



OBSTETRICS AND GYNECOLOGY. 491 

insanity, or insanity occurring during the lying-in period. 
It may result from heredity, primiparity, anxiety, dystocia, 
and septic infection. Some authorities attribute all the cases 
to septic infection. The disease appears with alarming ab- 
ruptness. Without warning the patient becomes maniacal 
or wildly delirious, and suffers from the most peculiar hallu- 
cinations. A homicidal or suicidal tendency is common. 25 
to 35 per cent, of the cases die from exhaustion or from septi- 
cemia, or remain permanently insane. The patient should 
be confined in a hospital and given nerve-sedatives, bromids. 
hyoscin, trional, sulf onal and tonics. Rest and mental diver- 
sion are essential. 

What hygienic precautions are necessary for a nursing 
child if the mother has sore nipples? 

If the nipples are fissured the child may suck in blood and 
suffer from hematemesis. It should temporarily be fed on 
the bottle or from a spoon, but returned to the breast as soon 
as the nipple will permit. An artificial nipple may also be 
used. 

Give the management in a case of (a) flat or inverted 
nipples, and (b) cracked nipples. 

A flat or inverted nipple requires gentle traction and manip- 
ulation during the last weeks of pregnancy, or more powerful 
suction through a breast-pump. If this does not succeed an 
artificial nipple must be employed. Fissured nipples should 
be kept clean and dry, and anointed between the nursing 
with sweet oil. In worse cases healing applications are neces- 
sary, as ichthyol in lanolin or glycerin, or I dram each of 
bismuth subnitrate and castor oil, compound tincture of ben- 
zoin, or a 4 to 8 per cent, solution of silver nitrate after 
cocainization. The child should not nurse from these nipples. 

Give the varieties, pathology, symptoms and treatment 
of puerperal mastitis. 

Mastitis or inflammation of the mammary gland may be 
suppurative or non-suppurative. It is almost always due to 



492 OBSTETRICS AND GYNECOLOGY. 

septic infection occurring through a fissured nipple. Occa- 
sionally it may result from caking of the breasts or milk- 
stasis. The pathology consists essentially in an acute inflam- 
mation of the cellular tissue of the gland. The symptoms 
are acute pain, inflammation, reddening of the surface, indu- 
ration, malaise, elevation of temperature and headache. The 
treatment consists in hot compresses of lead-water and laud- 
anum, the ice-bag, the application of a mammary binder, and 
ichthyol or belladonna locally; the child should not nurse. 
The bowels should be opened. 

Give the symptoms and treatment of mammary abscess. 

If mastitis advances to suppuration the symptoms will 
change. This is most common in the third or fourth week 
of the puerperium. The pain becomes dull and throbbing; 
rigor or chills are noted; the fever becomes hectic in type; 
the indurated portion of the breast becomes softer at a certain 
point, and fluctuation may be noted ; the surface of the gland 
becomes edematous, livid and glazed. When the abscess is 
situated deeply in the areolar tissue just above the pectoral 
muscles a postmammary or submammary abscess results. In 
this case the pus is very apt to burrow, and the gland is raised 
from the chest and becomes protuberant. The treatment of 
abscess is early incision, the line of incision radiating from 
the nipple ; the wound should be bathed in mercuric chlorid 
(1:4000) and packed with sterile gauze. 

What is the treatment of galactorrhea? 

Galactorrhea is an excessive flow of milk from the engorged 
breasts. It may be corrected by feeding the infant at regular 
intervals, and between the feedings the breast-pump may be 
employed to remove the excessive flow. Ergot may be admin- 
istered in small amounts, potassium iodid given in doses of 
10 grains three times daily, and belladonna ointment applied 
locally, or a 5 per cent, solution of cocain in equal parts of 
glycerin and water. 



OBSTETRICS AND GYNECOLOGY. 493 

To what dangers in pregnancy arid labor does gonorrhea 
of the mother expose her and her offspring? 

During pregnancy a gonorrheal woman may develop a pus- 
tube, which may rupture or cause an abortion and expose her 
to the development of septic infection. A gonorrheal woman 
is always in imminent danger of puerperal sepsis after the 
delivery of her child. The child is exposed to the danger of 
ophthalmia neonatorum. 

Give the symptoms, treatment and prognosis of oph= 
thalmia neonatorum. State its causes and the means of 
prevention. 

Ophthalmia neonatorum is a purulent inflammation of the 
conjunctiva of the infant due to infection at birth by gonor- 
rheal virus contained in the uterine and vaginal discharges. 
It is very virulent, and frequently results in total loss of sight 
from perforation of the cornea and destruction of the super- 
ficial tissues. The symptoms are reddening and edema of the 
palpebral, agglutination of the lids, profuse purulent dis- 
charge, a bright-red appearance of the conjunctivas, and later 
ulceration and perforation of the cornea. The prognosis is 
good unless corneal ulceration occurs. The treatment is 
mainly prophylactic and this consists in frequent vaginal 
douching during labor, and, immediately after the birth of 
the head, cleansing of the eyes with warm sterilized water, 
followed by the instillation of a few drops of a 2 per cent, 
solution of silver nitrate. After the disease has appeared 
the cleaning must be done hourly {Creole's method) with warm 
water, followed in alternate hours by mercuric chlorid 1 to 
5000 to 8000, and a saturated solution of boric acid. Twice 
daily an application of silver nitrate 4 per cent, solution may 
be used. The well eye should be protected with a collodion 
dressing. 

Give the pathology of hydrocephalus. State how hydro= 
cephalus may be recognized before delivery, and how such 
a complication should be dealt with. 

Hydrocephalus is a collection of serous fluid at some point 



494 OBSTETRICS AND GYNECOLOGY. 

within the cerebral substance (internal hydrocephalus) or 
outside the brain-substance (external hydrocephalus), pre- 
venting closure of the fontanels and causing enlargement of 
the skull. It is probably a sequel of some obscure form of 
inflammation of the cerebral meninges. The vaginal finger 
detects bulging fontanels and widely separated sutures, both 
yielding the sensation of fluctuation. Occasionally crepita- 
tion may be noted. Abdominal palpation reveals an unusual 
size of the head. The treatment consists in aseptic puncture 
through a fontanel or suture ; if this fails craniotomy is indi- 
cated. 

How may multiple (twin) pregnancy be recognized? 
State how it may complicate labor, and show how labor 
should be managed when this condition exists. 

A. twin pregnancy may be recognized by the unusual size 
of the abdomen, by the presence of two distinct fetal heart- 
beats, heard best at different points of the abdominal surface ; 
there may be two distinct placental souffles, irregularity in 
the outline of the uterus, the presence of a number of fetal 
extremities or parts, and the ability to outline two fetuses. 
The dangers are uterine inertia, abnormal presentations, im- 
perfect development of the fetuses, the formation of mon- 
strosities, and locking of the babies. The first child present- 
ing normally, labor should proceed normally; after its birth 
the second child should be made to present in a proper man- 
ner, and then 1 dram of the fluid extract of ergot should be 
administered. Not infrequently a forceps-delivery is re- 
quired. 

What complications may arise in a twin labor, and how 
may they be overcome? 

Malpresentation and malposition are frequent and must be 
corrected. Locking of the heads requires separation of the 
chins, the application of forceps or decapitation. 

What is superfetation, and how does it take place? 

Superf etation is the supposed fertilization of an ovum when 



OBSTETEICS AND GYNECOLOGY. 495 

there is another from a previous ovulation in uterogestation. 
There is considerable doubt as to the possibility of such an 
occurrence. If it does occur it will probably take place within 
the first few days after the primary conception, i. e., before 
the formation of the decidua. The occurrence of superfeta- 
tion at a more advanced stage in the development of the pri- 
marily fertilized ovum seems, however, to have been proved 
by remarkable cases reported by eminent men. 

What is meant by prolapse of the funis? When does it 
occur? What are its dangers? How would you manage 
such a case? 

Prolapse of the cord consists in the descent of a loop of the 
umbilical cord in advance of the presenting fetal portion. 
It occurs in certain malpositions and malpresentations of the 
fetus, in multiple pregnancy, in hydramnios with sudden 
escape of the liquor amnii, and in contracted pelvis when the 
fetal head does not properly fit into the superior strait. The 
danger is fetal death from asphyxiation due to pressure on 
the cord. The treatment consists in replacement of the cord, 
the woman resting in the knee-chest or Trendelenburg post- 
ure. This may be accomplished by gravity, aided by the hand 
or by a repositor. If this fails, podalic version may be per- 
formed or the child hastily delivered by forceps. 

What is premature respiration? 

The establishment of the function of respiration before 
delivery of the child has been accomplished. This is due to 
the entrance of air into the birth-canal, and occurs in cases 
of dystocia or during the performance of version. The dan- 
ger is insufflation of liquor amnii or clots, with the develop- 
ment of fetal pneumonia. 

How does constitutional syphilis in the parents affect 
the infant, and how r can you detect its presence in the 
infant? 

The offspring of syphilitic parents is generally infected by 
the disease. Congenital syphilis will be shown by the follow- 



496 OBSTETRICS AND GYNECOLOGY. 

ing symptoms: Undersize of the fetus, delivery at term of a 
still-born baby, syphilitic pemphigus on the palms and soles, 
enlargement of the liver and glands of the body, catarrhal or 
white pneumonia, and a line of fatty tissue between the epi- 
physis and diaphysis of the long bones. If the child be 
born alive and apparently healthy it will develop a coryza or 
"snuffles" at the expiration of four or five weeks, followed 
by the appearance of eruptions over the body and the devel- 
opment of marasmus. 

Give the causes and treatment of umbilical hemorrhage 
of the new=born child. 

Primary omphalorrhagia results from loose ligature or 
laceration of the cord, and occurs immediately after birth. 
Secondary hemorrhage occurs at the time of separation of the 
cord, and is due to a dislodgement of the clots or to the hem- 
orrhagic diathesis. The treatment consists in religation of 
the cord, the application of a firm compress with an astringent 
solution, the application of a firm plaster of Paris dressing, 
or of a figure-of-eight ligature applied over hare-lip pins. 

How would you decide whether a dead infant had been 
born alive? 

By the presence of air in the lungs (hypostatic test). 

What are the causes of still=birth, and how should a 
stiII=born child be treated? 

The causes of still-birth are various intra-uterine diseases, 
asphyxia from pressure on the cord or interference with the 
fetoplacental circulation, as in eclampsia or premature sepa- 
ration of the placenta, and traumatism during some obstetric 
operation. Such a child should be handled tenderly and 
be given a decent burial. The term * ' still-birth ' ' should not 
be confounded with asphyxia neonatorum. 

Give the etymology and uses of the forceps, and name 
the conditions for their application, together with the 
rules therefor and precautions to be observed in the same. 

The obstetric forceps (a Latin word) is an instrument with 



OBSTETRICS AND GYNECOLOGY. 497 

two 'blades and handles for pulling, grasping or compressing 
the fetus. Its use is indicated by the presence of uterine 
inertia, minor degrees of pelvic contraction, threatened fetal 
or maternal life, and to correct malpositions of the fetal head. 
In order that the instrument may be applied the os must be 
dilated, the membranes ruptured, there must not be too great 
disproportion between the head and the birth-canal, the part 
should be engaged, and the labor must be possible. The left 
blade is always introduced first, and must be grasped in the 
left hand and carried to the left side of the patient. It must 
not be forcibly thrust in, but must be slightly rotated in order 
to accommodate it to the pelvic and fetal curves. The blade 
that corresponds in name to the pelvic diameter in which the 
fetal presentation is lying must be pried forward in order to 
grasp the fetal head on the sides. 

Describe the common varieties of obstetric forceps. 

A short forceps is one in which the blades are attached 
directly to the handles without the intervention of a shank; 
it has the cephalic curve only, and is used only when the head 
is on the pelvic floor (low forceps operation). The long for- 
ceps is one in which a shank is placed between the handles 
and the blades ; it has a pelvic curve, as well as the cephalic. 
It may be used at the superior strait, but usually applied 
to the head in the pelvic cavity (median forceps operation) . 
The axis-traction forceps is a long forceps, in which, by an 
appliance or supplementary handle attached to the under 
surface of the blades, the traction force is constantly exerted 
in the line of the axis of the parturient canal. It is used at 
the superior strait (high forceps operation). 

Describe the position of patient and physician for the 
readiest means of applying the forceps. 

The patient in this country lies upon her back in the litho- 
tomy position, with the limbs flexed and the buttocks over the 
side of the bed. The physician sits on a chair between the 
thighs, which are separated and held by assistants. 
32 



498 OBSTETRICS AND GYNECOLOGY. 

In what direction should traction be made when the 
fetal head is in the cavity of the pelvis? 

At first downward and outward, then upward and backward. 
What powers may be exerted by the forceps? 

The forceps are generally used as tractors. They may be 
employed as levers, rotators and compressors. 

What are the dangers in the use of forceps, and how are 
such dangers to be avoided? 

The dangers are slipping of the instrument, septic infec- 
tion, laceration of the cervix and soft tissues, and fatal com- 
pression of the fetal head. If applied gently, without force, 
and in the proper (less) diameters of the fetal skull, and if 
thorough asepsis be employed, these dangers may be obviated. 

Describe the technic of the high forceps operation. 

The instrument ( axis- traction forceps) must be introduced 
through the cervix, and applied to the head in the best diam- 
eter possible. The grip is a vicious one, because a large diam- 
eter must be seized and there is danger of slipping. Traction 
is made well down at first, and as the head descends and the 
upper handles of the instrument rise the extra handles must 
be raised in order to keep the two handles together. When 
the head is low enough the instrument should be withdrawn 
and reapplied in a better position, or a simple instrument 
used. 

Describe the occasion for the application of the forceps 
in the inferior strait. 

This is a low operation. The blades are introduced in the 
manner already described, and traction made outward and 
downward until the floor is reached. The head is then pulled 
upward and outward and then upward and backward until 
it emerges through the vulvar orifice. The instrument in the 
last stage of delivery is grasped in the right hand only, as a 
dagger would be held, and the left hand spans the perineum 
in order to regulate the degree of distension. 



OBSTETRICS AND GYNECOLOGY. 499 

Describe the use of the forceps in the occipito=posterior 
position. 

This is a double forceps-operation. The occiput generally 
lies in the right oblique diameter (R. 0. P.). After applying 
the forceps in the manner already described traction is made 
downward and outward until the head impinges upon the 
pelvic floor. In the intervals of relaxation a certain amount 
of anterior rotation will take place. This will carry the occi- 
put through the transverse and into the left oblique diameter. 
The forceps must then be removed and reapplied in the new 
diameter to prevent inversion of the instrument. The final 
traction and delivery are as in the ordinary anterior forceps- 
delivery. 

What indications would lead you to insert a hand into 
the uterus, and what precautions should you observe? 

Failure of the placenta to descend, active post-partum 
hemorrhage, and the necessity for the performance of version 
are the indications for the introduction of the hand into the 
uterus. Thorough asepsis and antisepsis must be observed, 
and the hand must be anointed with an antiseptic ointment. 

Define version. Give the varieties, indications and 
dangers of version, together with the preliminaries and 
the method of operating. 

Version or turning is an obstetric operation whereby by 
manual efforts the position of the fetus in utero is altered so 
that one extremity of the fetal ellipse is made to take the place 
occupied by the other extremity or by some portion of the 
trunk. The varieties of version are: 1. Cephalic, in which 
the head is made to present ; 2. Pelvic, in which the breech is 
caused to present at the superior strait; and 3. Podalic, in 
which one or both feet are grasped and drawn down into the 
parturient canal. The indications for version are malposi- 
tion of the head and malpresentations, minor degrees of pelvic 
contraction, placenta prsevia, anything indicating speedy 
deliverv of the child, as threatened fetal or maternal life, and 



500 OBSTETRICS AND GYNECOLOGY. 

sudden death of the mother. The dangers of the operation 
are the introduction of septic matter or of air, with the pro- 
duction of air-embolism, rupture of the uterus, laceration of 
the cervix, and serious fetal injury. The patient should be 
anesthetized, and every antiseptic precaution observed. The 
membranes should not be ruptured until the hand is ready to 
be introduced. One foot should be grasped with the heel in 
the palmar surface and the child gently turned to avoid undue 
distension of the lower uterine segment. After the body is 
turned the case is treated as a breech presentation. 

Compare version with the employment of forceps, and 
state when each is preferable. 

Version is a shorter operation, and one 'that is to be pre- 
ferred when haste is required. The dangers of sepsis are 
greater than in the use of forceps, and also the danger of 
uterine rupture. Version should be used when the forceps 
fail to engage the head in minor degrees of pelvic contraction. 
Version cannot be employed when engagement has occurred 
or when there is a high position of Bandl's ring. 

Describe symphyseotomy, and give the indications for 
its performance. 

Symphyseotomy or division of the pubic symphysis is an 
extremely limited operation. It should be done, if done at 
all, only in those cases of pelvic contraction in which the con- 
jugate diameter of the superior strait measures from 7 to 8 
cm. The operation of choice is Uhe indirect method, in Which 
an incision 1% to 2 inches long is made above the symphysis 
in the median line, and after separation of the muscles the 
Galbiati knife is passed down beneath the symphysis and the 
bone divided from below upward and from within outward. 
As the symphysis separates gauze is packed in to arrest hem- 
orrhage. The forceps is then applied and the child extracted. 
After delivery the wound is closed and the bones held in appo- 
sition by means of a firm pelvic binder. 



OBSTETRICS AND GYNECOLOGY. 501 

Define embryotomy and craniotomy, and give the indi= 
cations for and method of operating in each. 

Embryotomy is any mutilating operation upon the fetus. 
It includes decapitation or beheading of the fetus, amputa- 
tions of the fetal extremities, evisceration, or removal of the 
viscera piecemeal, and craniotomy, or opening of the fetal 
skull, with evacuation of the brain. The technic of crani- 
otomy is as follows : Vaginal asepsis, fixation of the head and 
scalp with volsella-forceps, perforation through a suture or 
fontanel, enlargement of the perforation, disorganization of 
the brain-mass, decerebration by intra-cranial injections of 
warm carbolized water, crushing of the skull, and extraction 
of the head by the craniotractor. 

Give the various steps in embryotomy in the transverse 
presentation. 

If the fetus presents by the back, the operation of spon- 
dylotomy or division of the vertebrae is indicated, followed by 
evisceration or by delivery of the fetal body doubled upon 
itself. Spondylotomy or racliiotomy is performed by means 
of scissors, as is also evisceration. Occasionally in impacted 
shoulder presentations the operation of decapitation will be 
indicated. This can be accomplished by means of the blunt 
or the sharp hook or by scissors. The body is readily re- 
moved, and the head must then be grasped by forceps, 
crushed and extracted. 

Give the condition requiring Cesarean section or hys= 
terectomy, and describe a modified form of the operation. 

Cesarean section or delivery of the child through an abdom- 
inal and uterine incision is indicated in grave degrees of pel- 
vic contraction, in labor obstructed by tumors of the uterus 
and pelvis, in irreducible vaginal tumors, in rupture of the 
uterus, and in sudden maternal death. The original Cesa- 
rean section, in which an incision was made into the uterine 
wall and the child extracted, has been modified by Sanger as 
follows : The abdomen is opened in the median line, the uterus 



502 OBSTETRICS AND GYNECOLOGY. 

delivered and towels packed around it. Then while the uter- 
ine arteries are controlled by an assistant an incision is made 
into the uterus and the child and placenta extracted. The 
uterine cavity is cleaned out and sutures introduced to close 
the uterine incision, after which the 'abdominal wound is 
closed. 

Define Porro's operation, state when it is applicable, 
and describe the method of its performance. 

The Porro operation or celiohysterectomy consists in the 
extirpation of the uterus and its appendages after the extrac- 
tion of the fetus, as in the simple Cesarean section. The indi- 
cations for this operation are extreme degrees of pelvic con- 
traction, marked atresia of the cervix, vagina or vulva, the 
presence of large bony growths in the plevic canal, large 
fibrous or myomatous tumors of the uterus, extensive rupture 
of the uterus, with involvement of adjacent structures, a 
relaxed and flabby condition of the uterus after the section, 
and a septic condition of the uterus, with threatened general 
septic infection. The operation is the same up to extraction 
of the child. The ovarian and uterine arteries are then 
ligated and the uterus amputated at the cervical junction. 
The case is then treated as an ordinary abdominal section. 

What complications in labor justify abdominal section? 
Give the technic of the operation. 

The conditions that indicate Cesarean section, rupture of 
the uterus, retrodisplacement of the uterus with incarceration, 
extra-uterine pregnancy, labor complicated with tumors, grave 
septic infection of the uterus, appendages or broad ligament, 
all indicate abdominal section. The technic is that of Cesa- 
rean section with or without the removal of the uterus. 

Describe the malformations of the uterus. 

Owing to failure of development of the ducts of Miiller we 
have varying degrees of double uterus. The slightest degrees 
are known as uterus incudiformis and uterus cordiformis. 
From these minor degrees the uterine deformity may advance 



OBSTETRICS AND GYNECOLOGY. 503 

through the stages of uterus septus, subseptus, partitus, bi- 
partitus, bilocularis and semipartitus. In the uterus bicornis 
the two tubes unite below, but are separated above. The 
uterus unicornis results from a lack of development of one of 
the Mullerian ducts, its fellow undergoing the normal process 
of evolution. 

Describe and differentiate anteversion, retroversion and 
prolapsus of the uterus. State the obstetric significance 
of each. 

Anteversion of the uterus is a bending of that organ for- 
ward; retroversion is a bending backward; prolapsus is a 
falling down or descent of the organ. Anteversion may 
prevent a rising of the uterus if the organ be fixed, and so 
interfere with pregnancy. Retroversion of a pregnant womb 
may result in incarceration with serious results. Prolapse 
does not as a rule interfere with gestation ; the uterus returns 
to its normal position as gestation advances. 

Mention the symptoms and give the management of 
Iong=retained excretions due to imperforate hymen. 

In addition to menstrual suppression there will be noted 
cramp-like pains and a steadily growing cystic tumor in the 
median line of the abdomen. Palpation will elicit pain. Va- 
ginal examination will show the imperforate condition of the 
hymen. The treatment consists of thorough asepsis, followed 
by cervical incision into the hymen. As the tarry fluid es- 
capes a two-way catheter should be introduced and an anti- 
septic solution allowed to flow into the uterus in order to 
prevent shock from sudden evacuation and to prevent septic 
infection. 

What is vaginismus? How may it be recognized and 
treated? 

Vaginismus is painful spasm of the vagina and vulva. It 
results from rigid hymen, fissure and other local conditions, 
and appears at the time of coitus or digital exploration. It 
is best treated bv dilatation under anesthesia. 



504 OBSTETRICS AND GYNECOLOGY. 

What methods should be employed to dilate the non= 
pregnant uterus, and under what circumstances is the 
operation justifiable? 

The best method of dilating the uterus is the use of the 
dilator of Goodell or Wathens, the glove-stretching apparatus. 
This is required whenever there is stenosis of the cervical 
canal, or as a preliminary step to the operation of curettage. 

Is ventrofixation of the uterus justifiable? If so, state 
under what circumstances, and describe the operation. 

It is a safe and proper operation for the correction of 
retrodisplacement of the uterus in women past the child- 
bearing period. An abdominal opening is made, the uterus 
is brought forward, and a stitch is passed through the peri- 
toneal and subperitoneal tissues on one side of the incision, 
then through the fundus of the uterus on a line with the 
Fallopian tubes and through the corresponding tissues on the 
other side. A second suture must be passed a little back of 
this and firmly secured. The abdominal wound is then closed. 

Under what conditions may shortening of the round 
ligament become justifiable, and how should the operation 
be performed? 

Shortening of the round ligament may be performed when 
there is a retrodisplacement of the uterus. It is best per- 
formed by Wylie 's method or some other of the intraperitoneal 
methods, the ligaments being folded upon themselves or im- 
planted further back upon the uterus, Alexander's opera- 
tion is shortening of these ligaments in the inguinal canals. 

Define salpingitis, state its causes and pathology, and 
give its management. 

Salpingitis is inflammation of the Fallopian tubes. It may 
be septic, gonorrheal or tuberculous in origin, or merely a 
catarrhal condition. The mucosa swells, secretes a fluid, and 
if the edges of the fimbriae adhere a retension-cyst is formed. 
The treatment may be derivative, and consist in purgation, 
with local applications to the cervix and vaginal vault, or 



OBSTETRICS AND GYNECOLOGY. 505 

abdominal section may be performed and the appendages 
removed. 

Give the pathology of (a) hydrosalpinx, (b) hematosaN 
pinx. Give the diagnosis and treatment of each. 

Hydrosalpinx, or a watery collection in the tube, results 
from an old pyosalpinx or purulent collection. The pyogenic 
membrane has become destroyed, and the fluid slowly assumes 
the watery nature. Hematosalpinx, or blood in the tube, 
results almost invariably from an extra-uterine pregnancy. 
The treatment of each is excision. The diagnosis is made by 
the presence of a sensitive tumor in the situation of the tube, 
with pain on the affected side. 

Define endometritis, and give its causes, varieties and 
treatment. 

Endometritis, or inflammation of the lining membrane of 
the uterus, may be septic, gonorrheal, traumatic, catarrhal 
or tuberculous in origin, and occur as a glandular or as an 
interstitial affection, or as both combined. It may be 'treated 
by local applications, depletion, curettement, intra-uterine 
applications, or by excision of the uterus. 

Give the causes of pelvic inflammation, and state its 
relation to involvement of the ovary. 

Pelvic inflammation is generally septic or gonorrheal in 
origin. It may result from exposure to cold or wet or from 
abrupt stopping of the menstrual discharge. If active and 
virulent or long continued there follows a thickening and 
chronic inflammation of the ovarian capsule, which will result 
in follicular cysts forming in the ovarian stroma from in- 
ability of the Graafian follicles to rupture. 

Give a differential diagnosis between ovaritis and 
ovaralgia. 

Ovaritis, or inflammation of the ovary, is associated with 
all the symptoms of pelvic inflammation, including pain, leu- 
korrhea, hemorrhage, menstrual disturbance and swelling of 



506 OBSTETRICS AND GYNECOLOGY. 

the ovary or tumor-formation. There will also be general 
symptoms, as fever and prostration. Ovaralgia is neuralgia 
of the ovary, and may exist independently of any appreciable 
local lesion. It is more apt to occur at or near the menstrual 
period. 

Give the pathology and treatment of an ovarian cyst. 

An ovarian cyst may be follicular, as already described. 
It may be a multilocular cyst arising from rudimentary Graaf- 
ian follicles, and consisting of two or more loculi or com- 
partments; it may be a unilocular cyst springing from the 
parovarium, or it may be a papillary growth arising in the 
vertical tubules of the paroophoron. Whatever its origin 
and pathology, it should be removed by abdominal section. 

Give a description of cystocele and rectocele. State 
how each may complicate labor, and what should be done 
in the arising contingency. 

Cystocele is a prolapse of the anterior vaginal wall and 
posterior bladder wall ; rectocele is a prolapse of the posterior 
vaginal wall and anterior rectal wall. Both cystocele and 
rectocele encroach upon the calibre of the vagina, and may be 
caught by the advancing fetal head either arresting its pro- 
gress or being pushed before the head ; in the latter case the 
submucous tissue is torn and the vaginal prolapse made worse. 
The treatment consists in applying forceps to the head and 
drawing it over the relaxed vaginal walls. 

How would you diagnose cystic degeneration of the 
ovaries from other forms of disease which simulate it? 

From ascites ovarian cyst may be distinguished by the cen- 
trally situated tumor, the area of central dulness with coronal 
resonance, the immovability of the tumor, and the protuberant 
abdomen when the woman assumes the dorsal position. In 
ascites the abdomen flattens and the flanks bulge when the 
woman lies upon her back ; a change of position causes a cor- 
responding change in the area of dulness; fluctuation is 
marked; there is an area of central resonance with coronal 



OBSTETRICS AND GYNECOLOGY. 507 

dulness, and an associated grave organic disease may be de- 
tected. In phantom tumor the percnssion-note is hyper- 
resonant, and examination under an anesthetic reveals the 
true condition. 

Give the early diagnosis and the treatment of cancer of 
the uterus. 

A recurrence of bleeding after the menopause; an angry 
appearance of the cervix, which bleeds on the slightest touch ; 
a peculiar hardness of the mucous membrane due to cellular 
infiltration; an acid and irritating discharge, which may or 
may not be fetid, and dull sacral pains would lead to the sus- 
picion of cancer. A microscopic examination would then 
complete the diagnosis. The only treatment consists in total 
extirpation of the uterus. 

Give the diagnosis and treatment of anemia and chlo= 
rosis. 

Chlorosis is the "green sickness" of young girls. These 
girls are generally stout and well nourished, but present a 
peculiar green color; they suffer from nosebleed not infre- 
quently and attacks of vertigo and syncope. In true anemia 
there is an extreme pallor, with marked diminution in the red 
blood-corpuscles and hemoglobin and more or less wasting. 
Anemia is generally associated with some grave organic dis- 
ease. The treatment of both conditions consists in good food, 
change of scene, rest and tonics, including iron, strychnin 
and arsenic. 

What are the symptoms and treatment of amenorrhea? 

Amenorrhea is a total suppression of the menstrual flow. 
It is generally associated with anemic conditions, and may be 
accompanied by leukorrhea and vague pelvic pains. The 
treatment consists in tonics, good food, and the use of iron, 
oxalic acid, potassium permanganate, manganese and the 
other so-called emmenagogues. 

What is the menopause, and in what manner would you 



508 OBSTETRICS AND GYNECOLOGY. 

explain the theory that it is a critical period in a woman's 
life? 

The menopause is the cessation of the phenomenon of men- 
struation, occurring usually at the age of 43 to 45. At this 
time the ovarian influence ceases, and because of the tendency 
to the development of obesity and of uterine cancer at or 
after this period it has long been regarded as a critical period 
in the life of the woman. Various forms of insanity may 
also develop at this time. The post-climacteric diseases may 
assume a very serious aspect. 

Enumerate the perils of premature parturition. 

Premature labor subjects the woman to the dangers of 
hemorrhage from partial detachment of the placenta, cervi- 
cal laceration because of rigidity of the parts, and sepsis from 
retention of placental debris. 

What are the conditions liable to produce sepsis after 
abortion? 

Imperfect expulsion of the product of conception and the 
necessity in many cases of digital assistance. 

Before the head engages how would you convert an 
L. O. P. into an L. O. A. position? 

If possible by the position of the mother, who should lie 
upon the left side. If this fails the head may be rotated 
forward by the hand or by forceps applied to the sides and 
gently turned, not, however, reversing their normal position 
in the pelvis. One blade of the forceps, the vectis, may be 
employed for the purpose in suitable cases. 

What injuries may happen to the vagina and rectum 
during labor; and how may they be avoided? 

The vaginal walls may be pushed or drawn ahead of the 
advancing part and partially detached from their support; 
they may be cut or torn by the blades of the forceps, which 
may also cut through the rectovaginal septum and produce a 
complete perineal laceration. These accidents may be pre- 



OBSTETRICS AND GYNECOLOGY. 509 

vented largely by preservation of the bag of waters as long 
as possible, by thorough lubrication of the parts, and by the 
proper use of the forceps when these become necessary. 

Describe the method of applying forceps in R. 0. A. 
presentation. 

The head lies in the left oblique pelvic diameter ; therefore 
the left blade first introduced is pried forward until the 
blade rests over the upper fetal ear, the handle of the in- 
strument looking downward and outward to the operator's 
left. The right blade is then introduced land depressed with- 
out rotation until it fits into the slot of the other blade. 

Describe the operation in detail for the immediate repair 
of complete laceration of the perineum. 

After cleansing the parts, the patient being under an 
anesthetic, a stitch is passed well behind the anal orifice and 
toward the median line with an outward sweep, so as to em- 
brace the retracted sphincter fibers ; it is then carried up to the 
apex of the tear and caused to traverse a similar course upon 
the other side of the fissure, emerging at the point of intro- 
duction. A second stitch is then introduced at the point of 
retraction of the outermost sphincter-fibers and carried in 
and toward the apex of the tear, traversing a similar course 
on the other side to emerge at the outermost retracted 
sphincter-fibers of that side. These two stitches close the 
sphincter. The perineum above is then closed by transverse 
sutures introduced in the usual manner. If the rectal sep- 
tum is torn it must first be closed by a running catgut suture. 

Give the mechanism of delivery of a R. 0. P. presen= 
tation. 

After great labor-pains the head descends until the occiput 
strikes the pelvic floor high up posteriorly; it is then rotated 
anteriorly through % of a half circle until it rests under the 
pubic symphysis. While doing this the shoulders rotate high 
up in the false pelvis from right to left until they rest in the 
right oblique diameter, having primarily rested in the line 



510 OBSTETRICS AND GYNECOLOGY. 

of the left oblique diameter. The head is then delivered by- 
extension, rotation occurs toward the right, the anterior 
shoulder advances from the left side to the median line, and 
the shoulders and body are then delivered. 

What abnormal conditions in pregnant women are pre= 
judicial to the life of mother or child? 

Syphilis, tuberculosis, anemia, vomiting, zymotic diseases, 
placenta prsevia, pelvic deformities, renal disease, tumors and 
degenerations of the membranes. 

Describe the method of delivery in a leg=presentation. 

This is a modified breech-presentation. The leg should be 
drawn down and the other made to engage. The labor may 
proceed as a breech delivery, or the child may be rapidly 
extracted as after version. 

State the conditions compelling artificial feeding, and 
describe the proper method of modifying cow's milk for 
the newly born. 

Lack of milk-formation; refusal of the child to nurse; 
tuberculosis or other grave maternal disease; high fever. 
Normal cow's milk should be diluted by 10 or 12 parts of 
water, some sugar of milk added, lime-water 1 or 2 drams 
to the mixture, and the whole subjected to Pasteurization be- 
fore being administered in sterile bottles. 

Give the relations of the cephalic and pelvic diameter 
at 3 points during the birth of a L. O. A. presentation. 

At the beginning of the labor the suboccipito-bregmatic 
and bitemporal diameters of the head are concerned, the 
sagittal suture running in the right oblique pelvic diameter. 
After engagement perfect flexion causes the trachelo- 
bregmatic and biparietal diameters to engage. After anterior 
rotation the head rests in the conjugate pelvic diameter and 
the head is delivered by extending under the subpubic 
ligament. 



OBSTETRICS AND GYNECOLOGY. 511 

Diagnose pregnancy in the sixth month from phantom 
tumor. 

In phantom tumor there is general tympany over the dis- 
tended abdomen, there are no hard parts to be felt, and under 
ether the entire condition clears up. The pregnancy at six 
months will give all the absolute signs of pregnancy, includ- 
ing movements, heart-beats, and ability to outline the fetal 
parts. 

Differentiate an ovarian cyst, a uterine fibroid, and preg= 
nancy at the fifth month. 

At the fifth month of pregnancy there will be found a 
pyramidal tumor almost reaching to the umbilicus, cystic upon 
one side and firm upon the other, alternately hardening and 
contracting. The fetal outlines may be determined indis- 
tinctly, ballottement is present, and the soft signs of preg- 
nancy may be found. 

An ovarian cyst is of slower growth, is entirely cystic to 
the feel, fluctuation will be present, the tumor will be more or 
less to one side of the median line ; none of the signs of preg- 
nancy will exist ; menstruation may persist. 

A uterine fibroid will be much harder, irregular in outline, 
without the signs of pregnancy. Menstruation will be fre- 
quent and irregular, and increased in amount. 

Give the management of a pregnancy and labor compli= 
cated by a fibroid tumor of the uterus. 

If the tumor is large and the pregnancy early, abortion 
may be induced. In later pregnancies, the tumor being situ- 
ated on the anterior uterine wall, .the patient may be allowed 
to go to term and may spontaneously deliver herself. If not, 
Cesarean section is indicated. If the tumor is lodged in the 
pelvis or is in the posterior uterine wall elective Cesarean 
section with the Porro operation may be performed. 

Define multiple pregnancy. 

Pregnancy in which more than one fetus is present in the 
uterine cavity or in the maternal abdomen. 



512 OBSTETRICS AND GYNECOLOGY. 

Give the management of delay in the second stage of 
labor? 

If due to inertia, rest, firm abdominal binder, quinin, 
friction over the uterine fundus. If due to obstruction, as 
from rigid perineum, rigid cervix, tumor, or pelvic contrac- 
tion, correct the existing cause and deliver with forceps or 
by some other operative procedure. 

To what diseases is the puerperal breast liable? 

Fissure of the nipple, mastitis, abscess, septic infection, 
caking of the milk. 

Describe the vulva. Differentiate the vulva of a parous 
woman and the vulva of a non=parous woman. 

The vulva consists of the mons veneris and the two rolls of 
fatty tissue known as the labia majora. These parts are 
covered with hair. In a non-par ous woman the labia are 
in close contact, even when the thighs are separated; in a 
woman who has given birth to children the labia are either 
lightly in contact or the orifice is patulous and relaxed. 

Describe pelvimetry and state its obstetric uses and 
value. 

By pelvimetry is meant the measurement of the dimensions 
and capacity of the pelvis. It is employed to determine the 
degree of pelvic contraction that may be present, and the 
relationship existing between the respective sizes of fetus 
and pelvis. By its use grave major obstetric operations may 
be avoided by the premature induction of labor, or the oper- 
ation of choice may be selected and both fetal and maternal 
life saved. 

Describe the genupectoral posture and mention some of 
its important uses. 

The genupectoral or knee-chest posture is that in which 
the patient, resting upon her knees with the thighs vertical 
inclines her body forward until she rests upon the upper 
portion of the chest with the head turned to the side and the 



OBSTETRICS AND GYNECOLOGY. 513 

arms resting above the head. This position favors gravitation 
of the viscera out of the pelvis, permits a replacement of a 
retro- displaced uterus, the return of a hernia through the 
ring, and the replacement of a prolapsed funis. 

Describe the causes and management of a " head=last " 
labor. 

This is a breech-labor, and results from a reversal of the 
shape of the fetal ellipse, the cephalic extremity of the child 
becoming the larger; it may also depend upon a deformed 
uterus or a mild degree of pelvic contraction. The treatment 
consists in efforts at version before labor, if this be deemed 
best ; inaction during the first and second stages of labor un- 
til the child is delivered as far as the umbilicus, and then a 
rapid delivery of the shoulders and head. 
33 



THERAPEUTICS AND MATERIA 
MEDICA. 



For what purposes are diuretics employed? 

Diuretics are administered with the object of increasing the 
quantity of urine excreted: to promote the elimination of 
waste products and other poisons from the blood: to dilute 
the urine and to alter morbid conditions of the urine. 

Give the source, the common name and the principal 
therapeutic uses of oleum theobromae. 

Oil of theobroma is commonly called Cacao-butter. It is a 
fixed oil expressed from the seeds of theobroma cacao, the 
chocolate tree, which is found in Mexico, the West Indies and 
South America. Oil of theobroma consists chiefly of stearin 
with a little olein. It has a demulcent action. Its chief use 
is as a base for making suppositories. 

What are the varieties of sinapis used in medicine? 
How are they used and for what purpose? 

There are two varieties of sinapis (mustard), sinapis alba 
and sinapis nigra. It is directed, however, that pharmaco- 
pceial preparations be made from black mustard only. Lo- 
cally used, mustard is rubefacient, counter-irritant and a nerve 
stimulant, causing heat, redness and severe burning pain. 
Its prolonged application produces vesication by inducing 
local inflammation. Internally it is a local emetic in full 
doses; in smaller doses it has a carminative action. On the 
gastric mucous membrane its irritant effect is much less pow- 
erful than on the skin. Mustard is commonly used as an 
application to relieve local pain and to produce counter-irri- 
tation. Internally it may be employed as an emetic in indi- 

(515) 



516 THERAPEUTICS AND MATERIA MEDIC A. 

gestion or narcotic poisoning. Its use as a condiment is 
general. The oil of mustard is one of the most irritant of the 
volatile oils, producing severe gastro-enteritis. 

What are the causes and treatment of urticaria? 

Urticaria is an inflammatory affection, characterized by the 
eruption of pale-red, evanescent wheals, which are associated 
with severe itching. It is due to gastro-intestinal disturb- 
ances and emotional excitement. Chronic visceral diseases 
predispose. It is produced in susceptible individuals by cer- 
tain articles of food, as well as the bites of insects, and by 
certain drugs. Treatment : Remove the cause when possible. 
Especial attention should be paid to removing gastric irrita- 
tion and securing a free movement of the bowels with a saline 
laxative. The special remedies recommended are the alkalies, 
salicylate of sodium, quinine, iodide of potassium, atropine 
and antipyrin. Locally, lotions of water and alcohol, carbolic 
acid, boric acid or hydrocyanic acid are very useful. 

Name three drugs belonging to each of the following 
classes: narcotics, diaphoretics, ecbolics. 

Narcotics : opium, hyoscyamus and alcohol. Diaphoretics : 
pilocarpine, aconite and cocaine. Ecbolics: ergot, oil of rue 
and savine. 

What are the physiological effects and the therapeutic 
uses of Phytolacca? 

Phytolacca is an emeto-cathartic possessing slow but per- 
sistent action, with great nausea and considerable depression. 
It lowers the rate of respiration and of cardiac action, and is 
a motor depressant, paralyzing the spinal cord and the me- 
dulla. Death occurs from paralysis of respiration preceded 
by tetanic convulsions. The drug is said to possess alterative 
properties, and has been used internally and externally in 
chronic rheumatism and chronic skin affections. It produces 
the absorption of adipose tissue, and has been used as a 
remedy in obesity. Considering its physiologic action its 
employment is not justifiable. 



THERAPEUTICS AND MATERIA MEDIC A. 517 

From what source besides nux vomica is strychnine 
obtained? What other alkaloid is obtained from the same 
source? 

Strychnine is derived from Ignatia, St. Ignatius' Bean, 
which contains the alkaloids, strychnine and brucine, about 
1 per cent, of each. 

How do borax and boric acid differ chemically and thera= 
peutically? 

Boric acid, H 3 B0 3 , is a weak acid occurring in transparent, 
colorless six-sided plates. It is odorless, of a slightly bitter 
taste, and is soluble in 25 parts of water, in 15 of alcohol and 
in 10 of glycerine. Borax is the borate of sodium, Na 2 B 4 7 
-f- 10H 2 ; it occurs in colorless, transparent prisms of cooling 
and sweetish taste and alkaline reaction. It is soluble in 16 
parts of water at 59° F., and is insoluble in alcohol. Boric 
acid may be produced from borax by the action of sulphuric 
acid. The action of borax differs from that of boric acid in 
being a more powerful antiseptic and disinfectant, as well as 
being far more irritating when locally applied. 

Name the official preparations of gold and describe its 
therapeutic uses. 

Gold, aurum, has but one official salt, the gold and sodium 
chloride, but triturations of the metal itself may be prepared 
according to the general pharmacopceial formulae for such 
preparations. Gold has been recommended in certain forms 
of gastric disturbance, in chronic Bright 's disease, in certain 
nervous disorders, in impotence and in pertussis. It is not 
generally employed. 

What is the adult dose of (a) sulphate of atropin, (b) 
tincture of cantharides, (c) tincture of colchicum? 

(a) 1-200 to 1-50 gr. (b) 1 to 5 minims, (c) 20 to 90 
minims. 



518 THERAPEUTICS AND MATERIA MEDICA. 

Mention three alkaloids which are chemically alike and 
almost identical in physiologic effect. 

Cinchoninaa Sulphas, Cinchonidinse Sulphas and Quinidinae 
Sulphas. 

State the cause and give the treatment of trichinosis. 

Trichinosis is a typhoid condition resulting from the en- 
trance of a parasite, the trichina spiralis, into the intestinal 
canal and the subsequent migration of these parasites into the 
muscular structure. The trichina are introduced into the 
human body by eating infected hog's flesh, either raw or im- 
perfectly cooked. The preventive treatment consists in eating 
no pork that has not been perfectly cooked. If the parasites 
have been recently taken, emetics and purgatives are indi- 
cated. After migration has begun the powers of life should 
be sustained by nourishing food, stimulants and tonics. 

What drug is antagonistic to pilocarpine? 

Atropine in dose of 1-100 gr. for each 1-6 gr. of pilocarpine. 

Where is the habitat of belladonna? 

It is indigenous in the mountainous districts of central and 
southern Europe and Asia, and is cultivated in Europe and 
in the United States. 

What are the sources of sulphur? 

Sulphur is obtained native in several volcanic districts or 
from the native sulphides of iron and copper by roasting as 
it sublimes at about 238° F. 

In what dose may the oil of wintergreen be adminis= 
tered to an adult for rheumatism? 

Ten to twenty minims. 

How is nitrite of amyl administered and for what pur= 
pose? 

Nitrite of amyl is indicated for the same general conditions 
as nitro-glycerin. It is generally prescribed in glass pearls 
containing 3-5 minims, and these are broken in a handkerchief 



THERAPEUTICS AND MATERIA MEDIC A. 519 

and inhaled. It is a valuable heart stimulant, checks spasms 
and dilates peripheral vessels. It is especially employed for 
the relief of attacks of angina pectoris. 

Describe the therapeutic uses of sparteine and state the 
dose of the sulphate for hypodermic uses. 

Sparteine is the alkaloid of Scoparius, Broom, and is a 
valuable diuretic and heart stimulant. Its dose hypodermic- 
ally is from 1-16 to y 2 grain of the sulphate. 

What are the physiologic effects and the therapeutic uses 
of the balsam of Peru? 

Balsam of Peru is employed locally as a sedative and para- 
siticide. Internally it is of value as an expectorant in chronic 
bronchitis. This balsam is antiseptic, disinfectant, stimulant 
to the circulation and sedative to the nervous system, acting 
chiefly on the mucous membrane ; it is a tonic and expectorant, 
diuretic and diaphoretic. 

Give the common name, therapeutic uses and dose of 
sodium sulphate. 

Glauber's salt; it is a powerful purgative, and is prescribed 
in doses of 1 to 4 drams. 

Describe the therapeutic uses of sodium chloride. 

A bath may be made more stimulating for debilitated pa- 
tients by the addition of a few ounces of salt to the water. 
An enema containing one or two tablespoonfuls of salt to the 
pint of water is sometimes used effectively against thread- 
worms. The subcutaneous or intravenous injection of a 3-10 
per cent, solution of sodium chloride has proven of marked 
benefit in cholera, uremia and acute anemia from hemorrhages. 

State the composition and therapeutic uses of pulvis 
jalapae compositus. 

Compound powder of jalap contains of jalap 35 parts, of 
potassium bitartrate 65 parts, rubbed together until thor- 
oughly mixed. It is much employed to produce free watery 



520 THERAPEUTICS AND MATERIA MEDICA. 

evacuations in ascites and anasarca. Since it is nearly taste- 
less, it is a useful cathartic for children. 

What is a physiologic action of camphor in medicinal 
doses on (a) the skin, (b) the circulation? 

(a) Rubefacient; (b) increases the pulse rate and raises 
arterial tension. 

Describe the forms of poisoning by ergot. 

There are two forms, the acute ergotism and chronic ergot- 
ism. The symptoms of the acute form are nausea, vomiting, 
colic, difficult micturition and purging. The drug slows the 
heart, raises arterial tension, dilates the pupil and produces 
vertigo. It stimulates the contraction of unstriped muscle 
fiber, especially affecting the sphincters and uterus. In very 
large dose it produces cerebral and spinal anemia and violent 
convulsions. There are two varieties of the chronic ergot 
poisoning, the convulsive and the gangrenous. The convul- 
sions are tetanoid spasms of the flexor muscles, the uterus, the 
intestinal fibers and muscles of respiration, ending in coma 
and death by asphyxia. The gangrenous form begins with 
coldness and numbness of the limbs, formication of the skin, 
loss of sensibility and abolishment of the special senses, bullae 
of blood and ichor, followed by dry or moist gangrene of the 
lower extremities, buttocks and other parts, epileptiform con- 
vulsions, coma and death. 

In what pathologic condition is veratrum viride useful? 

Locally, veratrine is of value in neuralgia. Internally the 
drug is advised by some in the early stages of sthenic pneu- 
monia and in puerperal eclampsia. 

Mention the therapeutic uses of phenacetin. 

It is antipyretic, analgesic and hypnotic. It is useful in 
whooping-cough and rheumatic and other fevers. 

Give the name of the alkaloid of Calabar and state its 
dose. 

Physostigmine (or eserine). The dose of the sulphate is 
1-100 to 1-50 gr. 



THERAPEUTICS AND MATERIA MEDIC A. 521 

Mention the salts of lithium and describe their medic= 
inal uses. 

Benzoate, bromide, carbonate, citrate, salicylate and urate. 
The carbonate and citrate are used extensively in gout and 
the lithemie diathesis. The lithium salts have strong alka- 
line qualities, and act on the system as other alkalies. Lith- 
ium bromide is prescribed for the effects of bromide. 

What are the therapeutic uses of lobelia? 

It is used as an expectorant, diaphoretic, emetic, purgative 
and anti-spasmodic. 

Mention the official preparations of copper. Give the 
dose of each. 

There is but one official preparation, the sulphate, which is 
given as an emetic in doses of 2 to 5 grains every 10 or 15 
minutes, and as a tonic in dose of 1-6 to % grain. 

What are the therapeutic uses of oleum tiglii or Croton 
oil? 

Externally it is applied as a counter-irritant in bronchitis, 
neuritis, rheumatism and ovaritis. Internally it is used as a 
prompt hydragogue cathartic and revulsant in acute cerebral 
congestion, apoplexy and uremia. In these cases it not only 
causes general depletion, but also a rapid efflux of blood from 
the brain. 

What are the uses of the bromides? 

The bromides are used as sedatives to the nervous system, 
to lower reflex activity, to produce sleep, to subdue excitement 
of the genital apparatus and to antagonize congestion of the 
brain. 

Give the indications for the use of corrosive sublimate 
internally. 

As an antisyphilitic, as a hematinic, in gastric ulcer and 
early stages of hepatic cirrhosis and in dysentery. 



522 THERAPEUTICS AND MATERIA MEDIC A. 

What remedies are employed to correct anemic condi= 
tions and how are they used? 

Nux vomica, stimulates the blood-making organs, and is 
used as an adjunct to restorative remedies. Iron, the chief 
value of which is to improve digestion and to furnish hematin 
to the blood. The astringent preparations are the best, and 
should be given after meals. Arsenic as an adjunct to iron. 
Arsenic increases the number of blood cells, while the iron in- 
creases the hemoglobin contained in each. Bichloride of mer- 
cury, quinine and manganese increase the number of red blood 
cells. In the treatment of anemia it is of importance to 
determine the cause when possible. This will frequently be 
found to be due to gastro-intestinal irritation or constipation. 
General tonic treatment, with the proper diet and hygienic 
surroundings, are often more valuable than drug treatment. 

Describe the therapeutic uses of the preparations of 
phosphorus. 

Phosphorus is chiefly used to promote the nutrition of 
osseous and nervous tissue. Very small doses of the drug 
have been found of excellent service in functional impotence, 
in certain skin diseases, in pernicious anemia and in neuralgia. 
Calcium phosphate and the hypophosphites are used with 
benefit in all diseases of malnutrition and where the repair 
or development of the bones is required. They are particu- 
larly useful in protracted suppuration, osteomalacia, rachitis, 
caries, chronic phthisis and in the anemia and bone-softening 
of lactation. Sodium phosphate is a well known purgative. 

Indicate the manner in which ethylic ether (sulphuric 
ether?) should be applied to produce general anesthesia. 

As an anesthetic it may be administered from a sponge, a 
folded towel surrounded by a cone of pasteboard, or from an 
inhaler made especially for the purpose. At first the inhaler 
should be held some distance from the nose, to accustom the 
patient to the irritant effects of the ether, but soon it should 
be. brought close to the nose, so that the anesthetic may be 



THERAPEUTICS AND MATERIA MEDIC A. 523 

taken in concentrated form. Insensibility of the conjunctiva 
and muscular relaxation are the indications that the patient 
is properly prepared for the operation. Many surgeons now 
employ preliminary anesthesia with nitrous oxide gas. This 
greatly shortens the first stage and allows the patient to be 
anesthetized with a comparatively small amount of ether. 

In what manner is the system affected by an overdose 
of chloral hydrate? 

The ingestion of a toxic dose produces sleep, which soon 
deepens into coma ; the pulse becomes feeble and thready, the 
respiration embarrassed, the surface cold and clammy, the 
pupils at first contracted and then dilated, and finally death 
results from cardiac and respiratory paralysis. 

Name three general anodynes and give the dose of some 
official preparation of each. 

Opium, belladonna, cannabis indica. Morphine sulphate, 
% £ r - Sulphate of atropine, 1-100 gr. Extract cannabis 
indicae, 14 to y 2 gr. 

State the precautions which should ordinarily be ob= 
served in administering medicines by the hypodermic 
method. 

The medicine must be in solution, and the latter should be 
neutral in reaction and freshly prepared. The skin of the 
patient should be rendered aseptic at the place selected for 
the injection. The solution is to be injected beneath the skin 
and not into it, and the blood vessels and nerve points are to 
be especially avoided. 

Give the physiological effects of cinchona. 

Cinchona is an astringent bitter and a stomach tonic. At 
first it promotes appetite, digestion, the flow of saliva and 
gastric juice; long continued it sets up a gastric catarrh, 
impeding digestion and causing constipation. Its action is 
more astringent and irritating than that of its alkaloid, qui- 
nine. Its active principles are more slowly absorbed by rea- 



524 THERAPEUTICS AND MATERIA MEDICA. 

son of its bulk. In large dose quinine causes headache, ring- 
ing in the ears and some deafness. It is antipyretic and a 
heart depressant. On the nervous system it causes congestion 
of the brain and acts as a cerebral excitant; moderate doses 
lessen reflex activity by stimulating Setschenow's inhibitory 
center. Toxic doses permanently abolish the reflexes by de- 
pressing the spinal cord and peripheral nerves. Small doses 
exert no influence on the respiratory system, but large doses 
paralyze the respiratory center. 

Mention the conditions that contra=indicate the admin= 
istration of aconite. 

It is contra-indicated when there is adynamic action of the 
heart, cardiac degeneration or dilatation, and gastro-intestinal 
irritation or inflammation. 

Mention the alkaloids of mix vomica. 

It contains two alkaloids, strychnine and brucine. The 
latter resembles the former in its action, but is less powerful. 
The tincture of nux vomica is given in doses of 10 to 30 drops. 

For what pathologic conditions is salicylic acid admin= 
istered? What symptoms indicate the discontinuance of 
the use of salicylic acid? 

Externally it is used as an antiseptic in the dressing of 
wounds. Dissolved in collodion it is a valuable application 
for the removal of corns. The ointment is of service in 
chronic eczema. Internally, salicylic acid is of the greatest 
value in acute rheumatism. In neuralgia and neuritis of 
rheumatic origin it is of service, as it is in tonsillitis, pleurisy 
with serous effusion and in diabetes of gouty origin. It 
should be discontinued if the patient suffers from headache, 
ringing in the ears, deafness, paralysis of the ocular muscles, 
great fall of temperature, excessive sweating, difficult respi- 
ration, weak pulse, convulsions and olive-green urine. These 
are the symptoms resulting from a poisonous dose. 

For what conditions should (a) tincture of digitalis be 



THERAPEUTICS AND MATERIA MEDICA. 525 

given, (b) infusion of digitalis be given? Mention the 
dose of each. 

When the cardiac action of digitalis is desired the tincture 
should be employed, and no fluid should be taken within 
twenty minutes either before or after swallowing. If the 
diuretic action is required the proper preparation is the infu- 
sion. The dose of the tincture is from 5 to 20 minims. The 
dose of the infusion is from 1 to 4 drams. 

Write a prescription illustrating chemical incompati= 
bility. 

Salicylic acid is incompatible with the salts of iron; a pre- 
scription containing tincture of iron and salicylic acid would 
furnish an example of such incompatibility. 

Mention the principal physiologic effects of jaborandi. 
Give the alkaloids of jaborandi. 

Jaborandi is a powerful diaphoretic and sialogogue, a car- 
diac depressant, by stimulation of the vagus ends; it is also 
myotic, emetic and under some circumstances abortifacient. 
Jaborandi contains four alkaloids, pilocarpine, jaborine, pilo- 
carpidine and jaboridine. 

What are the earliest signs of poisoning from the ex= 
ternal use of carbolic acid? 

Early symptoms are smoky color of the urine, lumbar pain, 
slight cerebral disturbance, after which develops impairment 
of respiration and stupor. Applied in concentrated form it 
is irritant and superficially escharotic, and produces at the 
point of application a white spot, changing to red if the acid 
is soon removed. If the application is prolonged a white 
slough results from coagulation of the albumen of the tissue ; 
this is bordered by a red zone of inflammation. 

Mention the ingredients and the dose of pulvis glycyr= 
rhizae compositus. 

Compound liquorice powder contains senna 18, glycyrrhiza 



526 THERAPEUTICS AND MATERIA MEDICA. 

23%, oil of fennel 4, washed sulphur 8, sugar 50 ; the dose is 
one dram. 

For what conditions should blisters be applied? De= 
scribe the application of blisters. 

Blisters are applied for the purpose of producing counter- 
irritation. The proper manner of employing a counter-irri- 
tant to affect inflammation is not to apply it directly to an 
actually inflamed area, but a little to one side of it, at a spot 
knoAvn to be connected intimately with the diseased area by 
nerve fibers. 

By what other name is liquor potassae known? State 
the dose of liquor potassae. 

Liquor potassce is also called solution of potassa. Its dose 
is 5 to 30 minims well diluted with water. 

Mention the antagonist of cocaine. 

Ammonia and amyl nitrite combat the earliest symptoms 
of cardiac depression produced by cocaine. The most direct 
antagonist is chloral; then follow chloroform, ether and mor- 
phine. 

In what conditions is gallic acid useful? 

Gallic acid and its congener, tannic acid, are astringents, 
the former being the feebler of the two. They constringe the 
muscular tissue in the walls of the minute vessels, thus check- 
ing secretion and hemorrhage and cutting short local inflam- 
mation. Gallic acid is useful in hematuria, passive hemor- 
rhages, chronic cystitis, chronic diarrhea, bronchorrhea and 
night sweats. 

Describe the treatment of night sweats. 

The following drugs are found useful in the treatment of 
night sweats : Sulphate of atropine, in doses of l-75th gr. at 
bed time; gallic acid, in 15 gr. doses; camphoric acid, in 10 
gr. doses; and agaricin, in dose of 1-12 to % £ r - Sponge 
baths with weak solutions of alum and other astringents are 
sometimes employed. 



THERAPEUTICS AND MATERIA MEDICA. 527 

Describe gelsemium. State the dose of the preparations 
of gelsemium. 

Yellow jasmine is the rhizome and roots of gelsemium sem- 
pervirens, a climbing plant of the natural order Loganiceee, 
with showy yellow flowers. It grows in the forests of the 
southern United States. It contains a volatile oil, a resin and 
an alkaloid, gelsemine, in combination with gelsemic acid. 
Preparations are the fluid extract, dose 2 to 20 minims; the 
tincture, dose 10 minims to 1 dram. 

Mention the therapeutic uses of iodine. 

Iodine is a useful counter-irritant. Internally it is used 
chiefly for its alterative effect. In the form of Lugol's solu- 
tion (2 or 3 drops) it will sometimes control obstinate vom- 
iting. 

State the physiologic effects of physostigma on the res= 
piration, the heart and the pupil of the eye. 

Small doses do not affect the circulation or respiration, but 
toxic doses kill by paralyzing the respiratory center. The 
arterial pressure is raised by the drug stimulating the heart 
or its contained ganglia, and probably also by stimulating the 
vasomotor center. Toxic doses paralyze the heart. Physo- 
stigmine powerfully contracts the pupil. This results from 
stimulation of the peripheral fibers of the oculo-motor nerve 
and from paralysis of the peripheral filaments of the sympa- 
thetic nerve. 

Describe the physiologic action of phosphorus. 

In small doses phosphorus stimulates the brain and circula- 
tion, the functions of the stomach and the genital organs and 
the growth of bones. It aids digestion by irritating the end 
organs of the gastric nerve, but produces eructations of hydro- 
genic phosphide. 

Outline the therapeutic uses of atropine. 

Atropine is used in poisoning by opium, physostigma and 
hydrocyanic acid. In ptyalism from mercury, pregnancy, 



528 THERAPEUTICS AND MATERIA MEDIC A. 

etc., in the sweats of phthisis, in sudden cardiac failure and 
as a mydriatic. It is very useful in lead-poisoning, combined 
with potassium iodide. It is useful as hemostatic in profuse 
metorrhagia after abortion, in metorrhagia of obscure origin 
and in the hemoptysis of phthisis. 

Define sialagogue. Give an example of (a) topical siala= 
gogue, (b) general sialagogue. 

Sialagogues are agents which increase the secretion and 
flow of saliva and buccal mucus. Topical sialagogues act by 
reflex stimulation, as tobacco and mustard. General siala- 
gogues act through their influence on the glands or their 
secretory nerves, as pilocarpine and the mercurials. 

For what pathologic conditions is camphor used? 

Camphor may be employed in diarrhea, cholera, vomiting, 
cardiac depression, nervousness and nervous headache, the 
infectious fevers, dysmenorrhea, after-pains, and catarrhal 
conditions. Locally it is of use wherever counter-irritation 
or a local anodyne is required. 

Give the official name and the composition of (a) Fow= 
ler's solution, (b) Donovan's solution. 

Solution of potassium arsenite is a 1 per cent, solution 
prepared by boiling together arsenous acid 1, potassium 
bicarbonate 2, compound tincture of lavender 3, and distilled 
water to 100 parts. The solution of arsenic and mercuric 
iodide (Donovan's solution) contains arsenic iodide and mer- 
curic iodide, of each 1 part in 100 of distilled water. 

State the dose of (a) nitro=glycerine, (b) wine of col= 
chicum (sem.), (c) extract of colocynth. 

(a) 1-100 grain, (b) 20 to 90 minims, (c) 1 to 5 grains. 

Describe the therapeutic applications of sulphate of 
copper. 

It is a prompt and efficient emetic, and is so used in croup 
and narcotic poisoning. In phosphorus poisoning it forms a 
comparatively insoluble phosphide of copper, besides produc- 



THERAPEUTICS AND MATERIA MEDIC A. 529 

ing emesis. It is of value in acute diarrhea and chronic 
dysentery combined with opium. Locally it is employed in 
throat affections, gonorrhea, granular lids, corneal ulcers and 
chronic inflammation of mucous membranes. 

Mention (a) a hydrogogue, (b) a cholagogue. State the 
dose of each. 

(a) Elaterium, the active principle, elaterin, is given in 
doses of 1-20 to 1-12 gr., (b) podophyllum; dose 5 to 10 gr. of 
the extract. 

Mention four remedies used to control vomiting and 
state the dose of each. 

Cerium oxalate 2 to 5 gr., subnitrate of bismuth 5 to 20 gr., 
cocaine hydrochlorate 1-20 to % gr., acid carbolic in one-drop 
doses. 

Write a compound prescription for an adult suffering 
from insomnia, 

Jan. 1, 1903. Mb. John Smith. 

R . Potassii bromidi 5 iv 

Chloralis hydratis 3 iii 

Tincturse asafoetidse f £ iv 

Syrupi. = . ? • f 3 vi 

Aquae, q. s. ad. fgvi 

M. Sig. — Tablespoonful every two hours until sleep is induced. 

Jos. Jones, M. D. 

What are the uses of apomorphine? 

In narcotic poisoning, such as from opium or alcohol, apo- 
morphine is a valuable emetic. TVhen the circulation is weak 
it must be given cautiously. It is of service as an expectorant 
in the dry stage of acute bronchitis and in chornic bronchitis 
when the expectoration is viscid and scanty. The emetic dose 
of apomorphine hydrochlorate is from 1-12 to % gr. in alcohol. 
As an expectorant by the mouth the dose is 1-40 to 1-16 gr. 

State the effect of amyl nitrite on the vascular system. 

The inhalation of nitrite of amyl is speedily followed by 
flushing of the face, fulness in the head, quickening of the 
34 



530 THERAPEUTICS AND MATERIA MEDIC A. 

pulse and a fall of the blood-pressure. The flushing is due to 
dilatation of the arterioles, brought about partly by depres- 
sion of the vasomotor centers and partly by direct action on 
the blood-vessel walls. The quickening of the pulse results 
from a depression of the cardiac inhibitory centers in the 
medulla. The fall of blood-pressure is mainly due to dilata- 
tion of the vessels. Upon the heart the drug acts primarily 
as a stimulant, but in large amounts it soon acts as a cardiac 
depressant. 

Describe asafetida and outline its physiologic effects. 

Asaf etida is a gum-resin obtained by incision from the living 
root of ferula fetida, a perennial herb of the natural order 
Umbelliferae, native of Persia and Afghanistan. Its prin- 
cipal constituent is a sulphuretted volatile oil; it also contains 
a gum and a resin. It is a powerful anti-spasmodic, a stimu- 
lant to the brain and nervous system, a stimulant expectorant ; 
also tonic, laxative, diuretic, diaphoretic, emmenagogue, 
aphrodisiac and anthelmintic in action. 

State the effect of the bromides on the respiration and 
on the action of the heart. What effect is the long con= 
tinued use of the bromides liable to produce on the mental 
faculties? 

The bromides reduce the number of the respirations, and the 
heart's action and force, and through diminishing the calibre 
of the arterioles they lower arterial tension. The continued 
use lessens the activity of the brain cells, producing somno- 
lence. 

In what diseases is conium used? 

It is especially indicated in diseases characterized by exces- 
sive motor activity. It is useful in chorea, paralysis agitans, 
in acute mania and delirium tremens ; it is also employed in 
tetanus, asthma, Whooping-cough and other spasmodic affec- 
tions. 



THERAPEUTICS AND MATERIA MEDIC A. 531 

Define diaphoresis. Mention three diaphoretics and 
state the dose of each. 

Diaphoresis is a condition of sweating. Aconite, veratrum 
viride and the salicylate of sodium. The dose of aconitin is 
1-400 to 1-200 gr. The tincture of veratrum viride, 3 to 6 
drops. Salicylate of sodium, 10 to 20 gr. 

Mention ten drugs, the use of any one of which may 
cause skin eruption. 

Aconite, antimony,- antipyrin, atropine, quinine, tar, tur- 
pentine, salicylic acid, mercury, opium. 

Write a prescription containing a stomachic to be used 
in alcoholism. 

R . Tinct. Nucis Vomicae f 3 ii 

Tinct. Getitianae Qo f J iv 

M. Sig. — Teaspoonful before meals. 

What is the alkaloid of hyoscyamus? What is the dose 
of hyoscin hydrobromate for hypodermic use? 

It contains an alkaloid, hyoscyamine. The dose of hyoscin 
hydrobromate for hypodermic use is 1-200 to 1-50 gr. 

In what form is iodine most frequently administered in= 
ternally? What is the antidote for free iodine? 

Potassium iodide. Starch is the antidote to free iodine, but 
the stomach must-be immediately evacuated, as the iodide of 
starch is not inactive. 

Mention three commonly used myotics. 

Eserin is the only myotic generally employed in ophthalmic 
practice. Opium and pilocarpine are two other drugs pos- 
sessing myotic effects. 

State the effects of alcohol and strychnin on the arte= 
rioles. 

Alcohol causes a dilatation of the arterioles, while strych- 
nin contracts the arterioles, except in very large doses, when 
it produces relaxation of the smaller vessels. 



532 THERAPEUTICS AND MATERIA MEDICA. 

Describe the symptoms and give the treatment of gastro= 
duodenitis. 

The symptoms of gas tro- duodenitis partake of gastritis with 
an enteritis added, fever, gastric pain and vomiting, in addi- 
tion to which there may be colic and diarrhea. Simple catar- 
rhal jaundice will result from an extension of a gastro-duo- 
denitis into the common duct. The general symptoms of this 
condition are jaundice, loss of appetite, nausea, vomiting, a 
sense of fulness and constipation or irregular action of the 
bowels; there may also be slight fever. The treatment con- 
sists in saline aperients, which reduce the catarrhal inflam- 
mation ; and second, the use of such foods as do not require the 
bile to facilitate digestion. Skimmed milk, animal broths and 
egg albumen and copious drinking of water are advised. 

Mention the chief alkaloids and the therapeutic class of 
belladonna and of Calabar bean. 

Belladonna contains two alkaloids, the official atropine 
and belladonnine. Belladonna is a delirifacient. Calabar 
bean contains physostigmine and calabarine. It is a depresso- 
motor. 

Mention a soluble salt of lead. To what therapeutic 
class does bismuth subnitrate belong? 

Lead acetate. Bismuth subnitrate is classed with astrin- 
gents. 

What is the physiologic action of Indian hemp? 

Cannabis indica, Indian hemp, produces in full doses a con- 
dition of mental exhilaration associated with hallucinations 
and disordered consciousness of time, locality and personality. 
This stage of excitement finally gives way to sleep, which may 
last for several hours. Sensation is perverted and benumbed, 
and before sleep is induced there is often more or less general 
anesthesia. The drug has little influence upon circulation 
and respiration. 



THERAPEUTICS AND MATERIA MEDIC A. 533 

Mention three vegetable emmenagogues and state the 
dose of each. 

Ergot, the dose of the fluid extract is 1 to 2 drams; savine, 
the dose of the fluid extract is 5 to 15 minims ; tansy, the dose 
of the oil is 1 to 3 drops. 

Define therapeutic incompatibility, chemical incompatN 
bility. 

Therapeutic incompatibility arises when two agents are 
administered together which oppose each other in their physi- 
ologic actions. Chemical incompatibility is due to the union 
of two or more substances in combination whereby chemical 
change results. 

Write a prescription containing dilute hydrochloric acid, 
syrup of milk, cherry and camphor water for a cough. 
Write on this prescription the dose for an adult. 

Jan. 1, 1903. Mr. John Smith, 

R . Acidi hydrochloric! dil f 3 v 

Aquae camphorse f ^ i 

Syr. Pruni virginianse q. s. ad f ^ iv 

M. Sig. — Teaspoonful every four hours. 

Wm. Jones, M. D. 

State the dose of (a) fluid extract of belladonna, (b) 
extract of conium. 

(a) 1 to 2 minims; (b) 1 to 5 minims. 

In what pathologic conditions is uva ursae used? 

Uva utscb is employed as an antiseptic and stimulating diu- 
retic in chronic inflammatory affections of the genito-urinary 
tract, such as pyelitis, cystitis and urethritis. 

State the name and the dose of each of five official 
preparations of opium. 

Opii pulvis, a half to one grain ; extract of opium, % to 1 
grain; tincture of opium, 10 to 30 drops; camphorated tinc- 
ture of opium (paregoric), 1 to 4 drams; wine of ophim, 5 to 
10 drops. 



534 THERAPEUTICS AND MATERIA MEDIC A. 

In what diseases are preparations of arsenic useful? 

Locally, arsenic is useful in lupus and epithelioma. It is a 
valuable alterative in diabetes, chronic rheumatism, phthisis 
and asthma. In malaria it ranks next to quinine ; in the sim- 
ple chorea of childhood it is almost a specific. It is of great 
value in anemic conditions. 

State the name and dose of a drug belonging to each of 
the following classes: (a) emetics, (b) diuretics, (c) dia= 
phoretics, (d) cathartics. 

(a) Ipecac, the emetic dose of the fluid extract is 20 minims ; 
(b) digitalis, the dose of the infusion is 1 to 4 drams; (c) 
pilocarpus, dose of fluid extract is 10 minims; (d) jalap, the 
dose of the compound jalap powder is 20 to 40 grains. 

State the name and the alterative dose of a preparation 
of mercury capable of producing acute poisoning. Men= 
tion the chemical antidote for this preparation. 

Bichloride of mercury; dose 1-100 to 1-12 grain. In cases 
of poisoning by corrosive sublimate the stomach should be 
evacuated, the body temperature maintained and egg albumen 
given in large quantities as an antidote. 

How should asthma of cardiac origin be treated? 

The term cardiac asthma is applied to any shortness of 
breath which is the result of deranged cardiac action. The 
treatment is, of course, the treatment of the diseases which 
are responsible for it. Kest in bed is most important. The 
cardiac condition may indicate the need of digitalis, if, for 
instance, mitral regurgitation exists with loss of compensa- 
tion ; strychnine should be given if the heart muscle is weak; 
nitro- glycerine may be given in the early stages of arterial 
sclerosis. The particular treatment will depend upon the 
condition of the circulation. 

Outline the treatment of uremia. 

The name uremia is applied to a group of symptoms result- 
ing from the retention of toxic materials in the blood which 



THERAPEUTICS AND MATERIA MEDIC A. 535 

should have been eliminated by the kidneys. Sweating should 
be encouraged by the use of hot-air or vapor baths. Catharsis 
should be induced by croton oil in 1-drop doses or by elate- 
rium in % grain doses. The renal engorgement may be 
relieved by a dry or wet cup to the loins. Venesection is 
indicated if the patient is robust and the pulse is strong. If 
the pulse is weak, heart stimulants should be administered. 
If convulsions occur, 30 to 40 grain doses of chloral may be 
given by the rectum, or pearl nitrite of amyl inhaled. 

Describe the treatment of apoplexy due to cerebral 
hemorrhage. 

During the attack the head and shoulders should be slightly 
elevated and an ice-bag applied to the head. Prompt catharsis 
should be produced by croton oil, in a little glycerin, placed 
on the back of the tongue. If the pulse be strong, bleeding 
is indicated; if the pulse is feeble, hypodermic injection of 
such stimulants as strychnine and ammonia should be em- 
ployed. Bed sores must be prevented by frequently changing 
the patient's position and sponging with alcohol the parts ex- 
posed to pressure. During convalescence those predisposed 
to such attacks should lead a quiet life and avoid excitement. 
Iodide of potash should be administered over a long period. 
After the primary rigidity has appeared in the affected mus- 
cles galvanism and massage may assist in restoring lost func- 
tions. 

State the official name and the minimum poisoning dose 
of (a) strychnine sulphate, (b) morphine sulphate, (c) 
chloral. State the antidote for each. 

(a) Strychninae sulphas. The fatal dose of strychnine 
sulphate is placed by Taylor at y 2 to 2 grains for an adult, 
but recovery has taken place after much larger doses. The 
antidotes are chloral hydrate, tannic acid and animal char- 
coal, (b) Morphinse sulphas. Toxic dose depends on per- 
sonal susceptibility; % grain of morphine sulphate has killed 
an adult. Potassium permanganate is the best antidote if 



536 THERAPEUTICS AND MATERIA MEDICA. 

the morphine is in the stomach ; black coffee is also of value. 
(c) Chloral hydrate has caused death in several instances by 
a 30-grain dose. Atropine and morphine are its antidotes. 

Write a prescription containing the tincture of the chlor= 
ide of iron and the chlorate of potash, with the proper dose 
for a child four years old. 

Jan. 1, 1903. John Smith. 

R . Potassii chloratis gr. xvi. 

Tincturse ferri chloridi f 3 iss 

Ext. glycerrhizae g i 

Aquse, q. s. ad f ^ iv 

Sig. — A teaspoonful in water every three hours. 

John Jones, M. D. 
Criticize the following prescription: 

Tr. guaiac f 3 i 

Aq. cinnamon. i*^ ii 

Sig. — A teaspoonful every four hours. 
5, 12, '99. Dr. J. 

This is an example of pharmaceutical incompatibility. An 
alcoholic tincture should not be prescribed with aqueous solu- 
tions, nor should resinous tinctures be combined with aqueous 
solutions. 

What is the source of carbo ligni? What are the thera= 
peutic uses of carbo ligni? 

Carbo ligni is charcoal derived from soft wood. It is em- 
ployed as an absorbent of foul gases and as a deodorant and 
disinfectant. Internally it is useful in affections of the 
gastro-intestinal tract associated with hyperacidity and flatu- 
lent distension. 

Give the dose of (a) caffein, (b) wine of ipecac. 

(a) 1 to 5 grains; (b) y 2 to 6 fluid drams. 

What are the therapeutic uses of convallaria majalis? 

Lily of the valley possesses actions analogous to digitalis, 
strengthening the heart and increasing the flow of urine; it 
does not disturb the stomach and is not cumulative in its 
effects. 



THERAPEUTICS AND MATERIA MEDICA. 537 

Define a general anesthetic. Mention three general 
anesthetics in common use. 

A general anesthetic is a drag Which when inhaled suffi- 
ciently produces complete unconsciousness and loss of sensa- 
tion, also lessened motor power. The general anesthetics 
mostly belong to the alcohols and ethers. Ether, chloroform 
and nitrous oxide are three examples of such drugs. 

Mention three principal salts of potassium used in medi= 
cine and give the dose of each. 

Potassium bromide, dose % to 2 drams; potassium acetate, 
dose % to 1 dram ; potassium bicarbonate, dose y 2 to 1 dram. 

Of what is duboisin an alkaloid? What are the physio= 
logic effects of duboisin? 

Duboisin is the alkaloid of duboisia; it is believed to be 
identical with hyoscyamine, and strongly resembles atropine. 
It is a prompt mydriatic. In moderate doses it induces quiet 
and refreshing sleep, and is not dangerous. When given in 
large doses it may produce vertigo, nausea or syncope. It is 
less irritating to mucous membranes than atropine. 

What are the therapeutic uses of nitro=glycerine? By 
what other names is nitro=g!ycerine known? 

Nitro-glycerine is also known as glonoin and trinitrin. It 
is valuable in certain forms of cardiac disease, especially in 
sudden heart failure, angina pectoris and fatty degeneration 
of the heart. It relieves the high arterial tension and the 
dyspnea of chronic nephritis. 

Define materia medica, therapeutics. 

Materia medica treats of the substances used as medicines 
and describes their origin, composition, chemical properties, 
modes of preparation and administration, also their physio- 
logic and toxicologic actions. Therapeutics comprises all the 
science and art of healing, including the use of medicines 
and all other agents given with the object of curing disease. 



538 THERAPEUTICS AND MATERIA MEDIC A. 

What are the therapeutic uses of sulphur? 

Externally it is of value as a stimulant and parasiticide in 
diseases of the skin of chronic type. Internally it is a mild 
laxative. It is of use both internally and externally in chronic 
articular rheumatism. 

Outline the general treatment of acute articular rheu- 
matism. Write a prescription containing at least two 
ingredients for an adult to relieve pain in acute articular 
rheumatism. 

Rest in bed is essential. The joints should be wrapped in 
cotton-wool. The nourishment should consist of milk, beef 
tea, broths and gruel. The free use of lemonade or mineral 
waters is advisable. The best remedies are the salicylates and 
the alkaline salts of potassium. The following is a useful 
combination : 

B . Sodii salicylat 3 ii 

Potass, citrat. 3 iii 

Glycerini. 

Tinct. cardamom, comp aa f ^ ss 

Aquse, q. s. ad f £ v. M. 

Sig. — A tablespoonful every two hours. 

What are the therapeutic uses of strophanthus? Men= 
tion the dose of the tincture of strophanthus. 

Strophanthus is a valuable cardiac tonic, and may be em- 
ployed in the class of cases in which digitalis is indicated. 
The dose of the tincture is 3 to 10 minims. 

Define official preparations as applied to preparations of 
medicinal agents. 

All of those drugs which have gained entrance to the Phar- 
macopoeia are termed official preparations. 

What are the therapeutic uses of cardamom? 

It is used as an agreeable aromatic for disguising the taste 
of other drugs and as a carminative. 



THERAPEUTICS AND MATERIA MEDICA. 539 

What is the common name of staphisagria? What are 
the therapeutic uses of staphisagria? 

Staphisagria, stavesacre, is an unofficial drug. It is a vio- 
lent emetic, cathartic and parasiticide. 

Mention the preparations of ammonia. What effect has 
ammonia on the heart? 

The official preparations are aqua ammonias, aqua ammonias 
fortior, linimentum ammonias, spiritus ammonias, spiritus 
ammonias aromaticus. Moderate doses of ammonia increase 
the strength and rapidity of the heart, and this effect is pro- 
duced by a direct stimulation of the heart and its accelerator 
nerves. 

Write a compound prescription for an adult containing 
iron, quinine and opium in pill form for neuralgia. 

Jan. 1, 1903. John Smith. 

R . Pulveris opii gr. x 

Ferri sulphatis exsiccatse, 

Quininae sulphatis. aa gr. xi. 

M. et fiant in pilulae No. 20. 

Sig. — One every four hours. John Jones, M. D. 

Define tincture and spirits. 

Tinctures are alcoholic solutions of medicinal substances. 
Spirits are alcoholic solutions of volatile substances, which 
may be solids, liquids or gases. Tinctures, with the exception 
of the tincture of iodine, are made from non- volatile bodies. 

Mention three drugs used to accelerate the action of the 
heart and give the dose of some preparation of each. 

Atropine, dose of atropine sulphate 1-150 to 1-75 grain. 
Nitro-glycerine, dose 1-100 grain. Ammonia, dose of the 
aromatic spirits 20 to 60 minims. 

Give the treatment of obstinate hiccough. 

Rhythmic traction of the tongue will often arrest obstinate 
hiccough. Ether as a spray to the epigastrium for ten min- 
utes, then to the site of the phrenic in the neck, is also ad- 



540 THERAPEUTICS AND MATERIA MEDICA. 

vised. Morphine hypodermically, either alone or in combi- 
nation with atropine, has sometimes proven effective. 

What is the physiologic effect of cocaine on the ocular 
conjunctiva, the pupil of the eye and the salivary and 
sweat glands. 

Cocaine dropped upon the conjunctiva causes dilatation of 
the pupil and profound anesthesia of that membrane ; it also 
produces partial paralysis of accommodation, slight lachry- 
mation and sometimes temporary ptosis. It lessens the 
secretion of the salivary glands and the sweat glands. 

Write a prescription for a syphilitic adult containing cor= 
rosive sublimate and iodide of potassium in solution. 

January 1, 1903. For John Jones. 

& . Hydrargyri chloridi corrosivi gr. i 

Potassii iodidi • £ ii 

Tincturse gentianse comp. f ,| iii. 

M. et Sig. — A teaspoonful thrice daily after meals. 

John Smith, M. D. 

What are the therapeutic uses of tar? 

Tar is used as a stimulating expectorant and as a stimulant 
to the skin in certain chronic inflammatory diseases. 

What are the physiologic effects and therapeutic uses of 
chromic acid? 

Chromic acid exerts a powerful caustic effect upon all ani- 
mal tissue. It has a destructive action upon micro-organisms, 
and from the readiness with which it parts with its oxygen it 
rapidly decomposes organic matter, and so serves as a disin- 
fectant. It is not employed internally. It is a useful escha- 
rotic for destroying corns, warts, syphilitic vegetations and 
the like. 

Give the source and state the uses of thymol. 

Thymol is a phenol obtained from the volatile oil of thyme 
and certain other volatile oils. Thymol is used as a disin- 
fectant in the form of a wash, as an ointment in chronic skin 
diseases, and internally as an efficient antiseptic. 



THERAPEUTICS AND MATERIA MEDICA. 541 

What is the dose of croton oil as a cathartic? What are 
the contraindications to its use? 

The dose is % to 2 drops, given in glycerine or olive oil. 
It is contra-indicated when either debility, organic obstruc- 
tion or inflammatory conditions of the stomach or bowels 
exist. 

What are the physiologic effects and therapeutic uses of 
cubebs? 

Cubebs is an aromatic stomachic and a stimulant diuretic 
in small or medium dose, but large amounts derange digestion 
and may act as a gastro-intestinal irritant. Its constituents 
are eliminated by the bronchial mucous membranes, the skin 
and the kidneys, stimulating and disinfecting the genito- 
urinary passages, increasing the bronchial mucus, sweat and 
urine, and frequently causing an urticarial or vesicular erup- 
tion. It increases the action of the heart and the vascular 
system and promotes the menstrual discharge. Cubebs is used 
in the acute stage of gonorrhea, in chronic cystitis and chronic 
bronchitis. It is applied in powder form in hay fever, chronic 
nasal catarrh and follicular pharyngitis. 

Mention the therapeutic uses of carbolic acid except as 
an antiseptic. 

It is used as a caustic, local anesthetic, as an antiemetic and 
carminative. 

What is the treatment of scabies? 

Sulphur, styrax and naphthol are efficient local applications 
as ointments. 

An excellent formula is the following: 

Sulphur sublimat. 3 j 

Balsam Peruvians 3 ss 

Adipis. gj. 

M. et Sig. — Rub in thoroughly twice a day. 

How does an antagonist differ from an antidote? 

Antagonists are agents which oppose each other in their 



542 THERAPEUTICS AND MATERIA MEDIC A. 

physiologic action, and may be employed against each other 
as counter poisons to neutralize their effects upon the organ- 
ism. They do their work in the blood and tissues after ab- 
sorption, and are especially available against poisons admin- 
istered hypodermically, in which case antidotes are useless. 
Antidotes affect a poison so as to remove it from the body or 
alter its character before absorption, and thereby prevent its 
toxic action on the organism. They do their work in the 
alimentary canal or in the respiratory passages. (Potter.) 

Name and describe the methods of introducing medicines 
into the circulation. 

Medicines may be introduced into the circulation by various 
routes, including the mouth, the stomach, the rectum, the res- 
piratory tract, the veins and arteries, the subcutaneous cel- 
lular tissues and the skin. Intravenous medication is only 
used in emergencies where immediate action is desired. Saline 
solution is the usual remedy introduced by this route. The 
rectum will absorb any substances applied in the form of 
enemata or suppositories. The hypodermic method is the 
introduction of medicines into the organism by injecting them 
into the subcutaneous tissue, from which they are quickly 
absorbed by the lymphatic and capillary vessels. The respi- 
ratory tract admits of the rapid absorption of medicinal sub- 
stances through its extensive blood supply, especially by 
inhalation. The stomach is the most convenient organ for 
the absorption of medicine. The remedies find their way into 
the current of the circulation through the walls of the gastro- 
intestinal blood vessels and the lacteals. 

How do strophanthus and digitalis differ in physiologic 
action? 

Compared with digitalis, strophanthus is a powerful cardiac 
stimulant, differing from digitalis in not producing vaso- 
motor constriction of the arterioles. It reduces the pulse, 
lowers body temperature somewhat, is not cumulative in 
action, and does not cause any gastro-intestinal disturbance. 
It is a diuretic by direct stimulation of the renal circulation, 



THERAPEUTICS AND MATERIA MEDIC A. 543 

and has power over rigors by its rapid cardiac action, stop- 
ping them and preventing their recurrence. 

Mention the official turpentines. State from whence 
they are obtained. 

There are two official turpentines, terebinthina, a concrete 
oleoresin from Pinus palustris, the yellow pine, and other 
species of Pinus, natural order Conifera?; Terebinthina 
canadensis, a liquid oleoresin obtained from Abies balsamce, 
the balm of Gilead. 

Compare opium and belladonna as to action on the heart. 

Medicinal doses of belladonna quicken the pulse and raise 
the arterial pressure ; the quickening of the pulse results from 
depression of the inhibitory nerves and stimulation of the 
accelerators. The increased blood pressure is due to stimu- 
lation of the vasomotor centers and the heart itself. Toxic 
doses paralyze the heart. Opium in moderate doses has little 
effect upon the circulation. Large doses, however, stimulate 
the inhibitory nerves, centrally and peripherally, and thus 
slow the pulse; at the same time the latter becomes full and 
strong from stimulation of the heart or its contained ganglia, 
and possibly also from stimulation of the vasomotor centers 
in the medulla. Toxic doses finally paralyze both the heart 
and vagi and produce a rapid, feeble pulse. 

What are the therapeutic uses of ammonium carbonate? 

It is used principally as a stimulant in low fevers, like 
typhoid, and in acute pulmonary diseases associated with 
cardiac and respiratory weakness, such as croupous pneu- 
monia, catarrhal pneumonia and capillary bronchitis. 

Define solvent. Mention three principal solvents. 

Solvent is the term applied to the liquid before the sub- 
stance is added to it, by which addition after the operation is 
completed the combined preparation is called a solution. The 
chief solvents are water, alcohol and glycerine. 



544 THERAPEUTICS AND MATERIA MEDICA. 

What is the source of aloes? By what part of the intes= 
tinal tract is it eliminated? 

Aloes is the inspissated juice of the leaves of the Aloe soco- 
trina and other species of aloe. It acts chiefly on the lower 
half of the large intestine. 

Describe the physiologic action of alum. In what patho= 
logic conditions is alum useful? 

Alum is an astringent, coagulating the albumen and stimu- 
lating muscular contraction. At first it excites the flow of 
saliva and then diminishes it. It coagulates pepsin and 
arrests digestion, stops peristalsis and usually causes consti- 
pation, although sometimes it produces diarrhea. Although 
coagulating albumen even in weak solution, it enters the 
blood, arrests secretion, especially those of mucous surfaces, 
and stops capillary hemorrhages. It is used locally as an 
astringent in chronic catarrh, leucorrhea, gonorrhea, hemor- 
rhoids, bed sores, colliquative sweats, etc. The dried powder 
is escharotic, destroying granulation and warty growths. 
Alum is used as an emetic in smaller doses in gastric catarrh, 
gastralgia, lead colic, etc. 

Mention the ingredients of (a) Tully's powder, (b) 
Dover's powder. 

(a) Tully's powder is the compound powder of morphine. 
It has of morphine -sulphate 1 part to 19 of camphor and 20 
each of liquorice and calcium carbonate, (b) Dover's powder 
contains 10 parts ipecac, 10 parts of powdered opium and 80 
parts of sugar of milk. 

Why is atropine combined with morphine when the 
latter is administered? What is the dose of atropine 
when combined with morphine? 

Atropine has long been regarded as the physiological an- 
tagonist of opium. It especially combats the depressing 
effect of opium on the circulation. The hypodermic dose of 
atropine sulphate when combined with morphine is 1-150 
grain. 



THERAPEUTICS AND MATERIA MEDIC A. 545 

What is the physiologic action of veratrum viride on the 
circulation? 

It lessens greatly the force and rate of cardiac pulsation 
and reduces arterial tension by depression of the vasomotor 
center and of the heart itself. 

Give the physiologic action of senna and state what part 
of it is used in medicine. Where does senna grow most 
abundantly? 

The leaflets of Cassia acuti folia and of Cassia angustifolia; 
the former grows in Egypt and the latter in southern India. 
Senna is a brisk cathartic, producing in three or four hours 
after its ingestion copious watery stools. It acts by increas- 
ing both peristalsis and the intestinal secretion. It is ab- 
sorbed by the circulation. 

Describe bromism and state how it is produced. 

Bromism is produced by the continuous administration of 
the bromide. The condition is characterized by anemia, fetor 
of the breath, gastric disturbance, diminution of the reflexes, 
unsteady gait, impairment of tactile sensibility, abolition of 
sexual function, mental depression, failure of memory, som- 
nolence and a general eruption of acne. 

What are the therapeutic uses of sodium salicylate? 

It is of value as an antipyretic, as an anti-rheumatic and 
anti-neuralgic. It is of the greatest service in pleurisy with 
serous effusion, and is often useful in diabetes. When given 
early it will often abort tonsillitis. It is of service as a gastro- 
intestinal disinfectant. 

Give the dose of pilocarpine. 

The dose of pilocarpine hydrochlorate is 1-20 to 1-3 grain. 
Describe the therapeutic uses of hydrochloric acid. 

It is employed internally in the treatment of dyspepsia 
associated with subaeidity. It is useful as a refrigerant and 
digestant in the continued fevers. In conjunction with 
35 



546 THERAPEUTICS AND MATERIA MEDICA. 

strychnia it is of value in intestinal indigestion. The strong 
acid is also an escharotic. 

What are the principal uses of chloride of lime? To 
which ingredient does it owe its energy? 

Calcium chloride is of value as an internal remedy in the 
various manifestations of the strumous diathesis. It often 
causes the resolution of glandular enlargement, and is of value 
in chorea, lupus and eczema. It owes its energy to the cal- 
cium contained. 

What are the symptoms of opium poisoning? 

Unless the dose has been very large there is at first a stage 
of excitement, in which the imagination is stimulated and the 
feelings exalted. This stage is soon followed by depression; 
the patient becomes stupid and drowsy, and finally falls 
asleep. The sleep deepens into coma, the pulse becomes slow 
and full, the pupils contracted, the respiration slow and 
heavy and the face suffused. At this time it is still possible 
to arouse the patient by a loud noise, flagellation or shaking. 
In the third stage the coma becomes absolute, the pulse rapid 
and feeble, the breathing shallow and irregular, the skin 
moist, the muscles relaxed, the pupils dilated, and finally 
death results from paralysis of the respiration. 

Mention the remedy which will arrest the secretion of 
milk and state how it should be employed. 

Camphor used locally by inunction in saturated solution of 
olive oil is efficient in checking the secretion of milk, as is 
belladonna. 

Give the methods and the therapy of cold water treat= 
ment applied externally. 

Cold water may be applied in the form of cloths saturated 
with it, by sponging, bathing or packing with ice. The cold 
bath is the most frequently employed. A bath-tub half full 
of water at 70° F. is kept in readiness at the bedside of the 
patient, and whenever the temperature rises above 102.4° F. 



THERAPEUTICS AND MATERIA MEDIC A. 547 

the patient is wrapped in a sheet and carefully lifted into the 
tub. While in the bath cold affusions should be applied to 
the head, and the body should be constantly subjected to gen- 
tle friction and massage, so as to bring new relays of blood to 
the surface. A stimulant is often necessary to counteract 
the shock. After remaining in the water 15 to 20 minutes 
he is placed in a dry sheet and covered with a light blanket. 

What are the therapeutic uses of alcohol? 

The question of the advisability of employing alcohol in 
medicine has given rise to never-ending controversy. Many 
give it a high place, while others do not employ it at all. The 
external and local use of alcohol includes many applications 
of its antiseptic, refrigerant and rubefacient qualities. In 
the form of champagne it is especially valuable in controlling 
vomiting. A single dose of whiskey or brandy is an efficient 
combatant of fainting or of collapse. In fevers it acts as an 
antipyretic, a food, and promotes sleep. It is well to with- 
hold it until the first sound of the heart becomes feeble and 
dull, and then to use it boldly. It is of especial value in the 
treatment of pneumonia, typhoid fever and snake-bite. 

Mention the physiologic effects of bryonia. What is the 
dose of the tincture of bryonia? 

Bryonia is a pure irritant, setting up local inflammation 
wherever it is applied. It has a vesicant action on the skin, 
and is violently irritant to the serous and mucous membranes. 
It produces cerebral congestion, with frontal headache and 
vertigo. It is a drastic purgative and a powerful diuretic. 
It causes in full dose hepatic and renal congestion, vesical 
tenesmus and depression of the heart's action. The dose of 
the tincture is 5 drops to % ounce. 

State the dose of aconitin. 

4-hr to 2^0 of a g rain - 

Give the composition and state the uses of lotio hydrar<= 
gyri flava. 

Yellow wash is a favorite application for syphilitic sores. 



548 THERAPEUTICS AND MATERIA MEDICA. 

It is prepared by adding 18 grains of corrosive sublimate to 
10 ounces of lime water, producing the yellow oxide. 

Give indications for the internal use of bichloride of 
mercury. State the dose of bichloride of mercury for in= 
ternal use. 

It is of value in anemia, as an absorbent in diphtheria, as 
a general alterative, and is highly prized as an anti-syphilitic 
remedy in the secondary and tertiary stages. The dose is 
1-100 to 1-12 grain. 

What are the principal therapeutic uses of the salt of 
lead? 

Lead salts are chiefly used as astringents and hemostatics. 
The acetate is an efficient internal styptic. The nitrate is of 
value locally in epithelioma and unhealthy granulations. The 
iodide is employed locally to enlarged lymphatic glands and 
in chronic skin affections. The carbonate is only used exter- 
nally to protect irritated surfaces, such as intertrigo, etc. 

Explain the constipating action of opium. 

Opium arrests all the secretions except the milk and the 
sweat, and retards the digestive juices. The biliary and 
glycogenic functions of the liver are affected and metabolism 
greatly reduced. Its constipating action is produced chiefly 
by stimulation of the inhibitory nerves of the intestines 
through the splanchnics. 

Mention the symptoms of poisoning by phosphorus. 

Toxic doses of phosphorus produce, after the lapse of a few 
hours, a garlicky taste in the mouth, thirst, intense abdominal 
pain, obstinate vomiting, restlessness and prostration. The 
ejected materials contain mucus, bile, and occasionally dis- 
integrated blood, and are luminous in the dark. At the end 
of 24 or 36 hours the symptoms gradually subside and the 
patient feels comparatively comfortable, but soon jaundice 
develops, the vomiting and pain return, the liver becomes 
enlarged and painful, the urine contains albumin, bile, hypo- 



THERAPEUTICS AND MATERIA MEDIC A. 549 

phosphoric acid and crystals of leucin and tyrosin. The 
tongue is coated, the breath offensive, the belly distended, 
the bowels either constipated or loose and the stools clay- 
colored and sometimes phosphorescent. Death is generally 
preceded by grave nervous symptoms, such as headache, de- 
lirium, convulsions, stupor and coma. When recovery follows 
convalescence is protracted and tedious. 

Write a prescription containing a sedative and an ex- 
pectorant for a bronchial cough in a three=year=o!d child. 

January 1, 1903. For Walter Smith. 

R . Tinctura opii camphoratse gtt. lxiv 

Potassii citratis 3 ii 

Syrupi pruni virginianse, q. s. ad • - • f ^ iv. 

M. Sig. — Teaspoonful every four hours. 

Wm. Jones, M. D. 

In what pathologic condition is jaborandi useful? 

It is of use in dropsy, especially of renal origin, in uremia, 
inflammation of the serous membranes, in diabetes insipidus, 
but is contra-indicated when the heart's action is weak. It 
is useful in the form of a lotion for alopecia. 

What is the dose of carbolic acid for internal adminis- 
tration? 

Dose % to 2 grains well diluted. 

What is the common name of lactucarium? State the 
physiologic action of lactucarium. 

Lettuce. Lactucarium is feebly hynotic and somewhat 
sedative and diuretic. It acts feebly. The syrup is a good 
vehicle for expectorants and anti-spasmodics. 

What is the physiologic action of colchicum? 

Emetic, diuretic, diaphoretic, a drastic purgative and car- 
diac depressant, gastro-intestinal irritant. In small doses it 
is an emeto-cathartic. 

What serious results may ensue from indiscriminate use 
of acetanilid? 

A toxic dose destroys the ozonizing function of the blood 



550 THERAPEUTICS AND MATERIA MEDICA. 

and forms methyl-hemoglobin, causes fatty degeneration of 
the heart, liver and kidneys in animals poisoned by it. When 
administered continuously or in too great dose it is apt to 
cause subnormal temperature, cyanosis and collapse. 

What is cascara sagrada? State the dose of the fluid 
extract of cascara sagrada. 

It is the bark of Rhamnus purshiana, California buckthorn. 
The dose of the fluid extract is y 2 to iy 2 drams. 

What are the therapeutic uses of tincture of capsicum 
internally administered? State the dose of the tincture 
of capsicum. 

It is employed chiefly as a stomachic and carminative. A 
weak solution of the tincture is also a much used gargle in 
sore throat with relaxed uvula. The drug is especially valu- 
able in alcoholic gastritis and obstinate constipation. The 
dose of the tincture is 5 to 10 minims. 

What part of aconite is used in medicine? What is the 
alkaloid of aconite? 

Aconite is derived from the root of the aconitum napellus. 
Its most important alkaloid is aconitine. 

Write a prescription for corrosive sublimate to be used 
as a parasiticide. 

January 1, 1903. For John Jones. 

Hydrargyri bichloridi gr. ii 

Unguenti petrolati f ^ i. 

M. et Sig.— Use locally. John Smith, M. D. 

How is liquor ammonii acetatis prepared? In what 
conditions is this preparation useful? 

Spirit of Mindererus is prepared by neutralizing dilute 
acetic acid with ammonium carbonate; it should be freshly 
made, as it soon deteriorates. It is an active diuretic if the 
body be cool, and a diaphoretic if the body be warm. In 
wineglassful doses it will counteract many of the immediate 
effects of alcohol. 



THERAPEUTICS AND MATERIA MEDIC A. 551 

Give the therapeutic uses of sodium phosphate. 

In doses of y 2 ounce it is a mild purgative. It has been 
recommended in catarrhal jaundice and cholelithiasis. 

State the ingredients and uses of sulphur ointment. 

Sulphur ointment is made up of 30 parts of sublimed sul- 
phur and 70 parts of benzoinated lard thoroughly mixed. 
Sulphur ointment is used in certain forms of skin diseases 
and as a means of administering sulphur when it is not well 
borne by the stomach. 

Give the composition and the chief use of lotio hydrar= 
gyri nigra. 

Black-wash is prepared by adding 30 grains of calomel to 
10 ounces of lime water, producing the black oxide, and is used 
as an application to syphilitic sores. 

What are the therapeutic uses of Pulsatilla? 

Some therapeutists regard the drug as of no value whatever ; 
others claim good effects from its employment as an emmena- 
gogue, a diuretic and diaphoretic; it is also a cardiac and 
vascular sedative, and possesses some antipyretic action. 

Where is quassia indigenous? What part of the plant 
is used in medicine? 

The West Indies. The wood is used. 

What is the common name of ferrous sulphate? Give 
the chief uses of ferrous sulphate. 

Copperas: it is impure ferrous sulphate. It is chiefly used 
to make the dry sulphate and other preparations. It is some- 
times employed as a tonic astringent. 

Describe the physiologic action and the therapeutic use 
of guarana. 

Guarana has similar actions to those of coffee, the active 
principle of both plants being perhaps identical. It may be 
used in migraine, in convalescence in acute diseases, in diar- 
rhea of phthisis, etc. 



552 THERAPEUTICS AND MATERIA MEDIC A. 

Give the composition of Vienna paste (pasta caustica 
Viennensis). 

It is a grayish-white deliquescent powder consisting of 
equal parts of potassa and lime rubbed together. 

Explain the distinction between physiologic action and 
the therapeutic use of medicinal agents. 

The physiologic action of a drug is its effect upon the 
economy in health, and includes its action upon the nervous 
centers, respiration, circulation and metabolism. From its 
physiologic action is deduced its therapeutic indication or 
employment in certain diseased states. 

Define a mydriatic. Give three examples, with the dose 
for the local application in each case. 

Mydriatics are agents which produce dilatation of the 
pupils. Atropine is used locally in solutions of 8 grains to 
the ounce. Homatropine, in strength of 4 grains to the 
ounce. Cocaine locally in a 5 per cent, solution. 

Define germicides, parasiticides. 

Germicides are agents that destroy germs, as solutions of 
bichloride of mercury, permanganate of potash, carbolic acid, 
etc. Parasiticides are agents which are destructive to para- 
sites; the principal parasiticides are mercurial ointment, sul- 
phur and acetic acid. 

What results from combining silver nitrate and creo= 
sote? 

An explosive compound, which is white in color, without 
odor, and has the appearance of an emulsion. 

What symptoms are produced by toxic doses of tartar 
emetic? 

Pain, vomiting, diarrhea, with watery stools and collapse, 
motor and sensory paralysis and suppression of the urine. 

Mention two remedies commonly used to increase in= 
testinal peristalsis. 

Senna and rhubarb. 



THERAPEUTICS AND MATERIA MEDIC A. 553 

What are the therapeutic uses of buchu? 

Chronic affections of the genito-urinary mucous membranes, 
lithiasis, prostatic affections, atonic dyspepsia and chronic 
rheumatism. 

What is the ultimate effect on the heart's action of 
medicinal doses of belladonna? 

Following the ingestion of belladonna the heart rate is at 
first slowed, but soon becomes rapid and vigorous, and the 
arterial tension is increased; this is accomplished by stimula- 
tion of the cardiac sympathetic and paralysis of the pneumo- 
gastric, thus stimulating the accelerator apparatus while 
lessening the inhibitory. 

Compare the strength of dilute hydrochloric acid with 
that of the absolute acid. What is the dose of the former? 

Dilute hydrochloric acid is a 10 per cent, solution of the 
absolute acid in water. Its dose is 3 to 10 minims. 

How do styptics and hemostatics differ? Give an ex= 
ample of each. 

These are agents which arrest bleeding, styptics being those 
which are applied locally, as alum, and hemostatics those which 
are administered internally, as gallic acid. 

What part of zingiber is used in medicine? What are 
its therapeutic uses? 

The rhizome. The official preparations are fluid extract, 
tincture, syrup, troches and the oleoresin. It is employed as 
a carminative and as an adjunct to purgative medicine to pre- 
vent griping; the syrup is commonly employed as a flavoring 
adjuvant. 

Define pharmacy. 

Pharmacy is the art of selecting and preserving medicines 
and preparing them for administration. 

How do therapeutic agents act to promote waste? 

Destructive metamorphosis of the tissues is promoted by 



554 THERAPEUTICS AND MATERIA MEDIC A. 

alteratives and astringents. The manner in which alteratives 
act has never been determined. We know that of such 
drugs as mercury and iodine, the former being endowed 
with the power of breaking up newly deposited fibrin and 
disorganizing syphilitic deposits, and the latter acts ener- 
getically upon the lymphatic system and promotes absorption. 

Mention the principal therapeutic application of anti= 
pyrin. 

Antipyretic, analgesic, antiseptic, as a local anesthetic and 
to diminish secretion, as an anti-galactagogue. 

What is the dose of curare for hypodermic use? What 
are the antagonists of curare? 

1-20 to % grain. Strychnine, atropine, and more effective 
still, artificial respiration. 

What is codein? State the dose of codein. What are 
the advantages of codein over opium? 

Codein is an alkaloid of opium, differing from morphine in 
having the radical CH 3 replacing an atom of hydrogen. It is 
less irritating to the digestive tract than opium. Its dose is 
% to % of a grain. 

Mention the therapeutic uses of creosote. 

Locally as an anesthetic and antiseptic. Internally as an 
antiseptic, in chronic gastric catarrh, in diarrhea, dysentery 
and phthisis. 

What is the common name of hamamelis? State the 
dose of the fluid extract of hamamelis. 

Witch-hazel. The dose of the fluid extract is 1 minim to 1 
dram. 

What part of buchu is used in medicine? State the dose 
of the fluid extract of buchu. 

The leaves. Dose of the fluid extract 10 minims to 1 dram. 

What is the official name of tartar emetic? State the 
dose of tartar emetic. 

Antimonii et potassii tartras. Dose y ¥ to % of a grain. 



THERAPEUTICS AND MATERIA MEDIC A. 555 

What are the uses of cantharis (a) externally applied, 
(b) internally administered? 

Externally it is employed as a vesicant and internally as a 
stimulant to the geni to-urinary tract. 

What is pepo? State its therapeutic use. 

Pumpkin-seed. It is used as an anthelmintic against tape- 
worms. 

Describe the physiologic action and the therapeutic uses 
of scammonium. 

Scammony is a powerful irritating hydragogue cathartic. 
It may be used in combination with other cathartics in obsti- 
nate constipation. 

Mention the preparations of ergot and give the dose of 
each preparation. 

The extract of ergot, dose 5 to 20 grains ; the fluid extract, 
dose 1 to 2 drams ; the wine, dose 2 to 4 drams. 

Define hematics. Mention two principal hematics. 

These are medicines which increase the quantity of hematin 
in the blood. They consist chiefly of iron and manganese and 
their compounds. 

What are the physiologic effects of iodoform internally 
administered? State the therapeutic uses of iodoform 
when externally applied. 

In small doses internally iodoform is considered to be a tonic 
and alterative. If taken over a protracted period it may cause 
profuse salivation. In toxic doses it causes pyrexia, then 
headache, quick and feeble pulse, marked anxiety and restless- 
ness; collapse and death may suddenly supervene. Locally 
its action is anesthetic and powerfully antiseptic. It is one 
of the best agents to prevent decomposition, and it destroys 
the germs of putrefaction and of disease, but must be carefully 
employed. 



556 THERAPEUTICS AND MATERIA MEDIC A. 

Give the dose of (a) liquor potassii arsenitis, (b) liquor 
sodii arsenitis. 

(a) 2 to 8 minims freely diluted, (b) 2 to 8 minims freely 
diluted. 

Define emulsion. 

Emulsions are liquid preparations containing an insoluble 
medicinal substance, as an oil or a resin, in a state of minute 
subdivision, and suspended by the aid of some viscid excipi- 
ent, as gum, which may be contained in the medicinal ingre- 
dient itself or be added by the pharmaceutist. 

Where is the habitat and what are the physiologic effects 
of digitalis? 

It grows wild in Europe and is cultivated in this country. 
The dominant action of digitalis is on the circulation. In 
therapeutic doses it slows the pulse and raises the blood pres- 
sure. The slowing of the pulse results from a prolongation 
of the diastole, and this in turn is due to stimulation of the 
vagi or inhibitory nerves. The increased blood pressure is 
due to a powerful stimulant effect on the heart and to a con- 
traction of the arterioles resulting indirectly from stimulation 
of the vasomotor center and directly from the action of the 
drug on the vessel wall. Toxic doses quicken the pulse by 
paralyzing the vagi and lower the arterial pressure by causing 
a powerful systolic contraction so that the diastole becomes too 
imperfect to permit the ventricles to be completely filled. 
Therapeutic doses have no effect on the nervous system, but 
toxic doses lessen the reflexes, first by stimulating Setsche- 
now's inhibitory centers and later by depressing the spinal 
cord. It requires toxic doses to influence the respiration, 
and then slowing occurs. Large doses occasionally produce 
nausea, vomiting and diarrhea. In health digitalis has little 
or no diuretic action. "When the urine is diminished from 
embarrassment of the circulation it produces free diuresis, 
which is attributed to its effect on the heart and vessels, and 
not to a direct influence on the secreting structure of the 
kidney. 



TEEBAPEUTICS AND MATERIA MEDIC A. 557 

What parts of gossypium are used in medicine? 

The bark of the root is official, as gossypii radicis and the 
hairs of the seed, as gossypium purification. 

What is the important alkaloid of erythroxylon and 
what is its principal therapeutic use? 

Its alkaloid, eocain, is allied to caffein, but is more power- 
ful, and its proportion in the leaves of the plant varies greatly 
in the different samples which occur in commerce. Its chief 
use is that of a local anesthetic. 

Name the official preparations of bismuth and give the 
dose of each. 

Bismuth citrate, used only for pharmaceutical purposes ; 
bismuth and ammonium citrate, dose 1 to 5 grains ; bismuth 
subcarbonate, dose 5 to 30 grains; bismuth subnitrate, dose 
5 to 30 grains. 

What is the physiologic action of iris? 

Iris when fresh is actively purgative, emetic and diuretic, 
producing severe nausea and prostration. 

What is the dose of (a) potassium iodide, (b) ammo= 
nium iodide, (c) sodium iodide? 

(a) Potassium iodide, 5 to 60 grains; (b) 2 to 10 grains; 
(c) 5 to 60 grains. 

From what is koumiss made and what are its thera= 
peutic uses? 

Koumiss is an effervescing fermented liquor originally pre- 
pared by the Tartars from mares' milk, but now imitated with 
cows' milk by adding sugar of milk, fermenting in an open 
tank, skimming off the casein and butter, then bottling during' 
active fermentation. Koumiss is an invaluable article of 
diet in many wasting diseases, especially tuberculosis. It is 
of great benefit in dyspepsia, the diarrheas of children, con- 
valescence from acute maladies, chronic affections of the kid- 
neys, chronic bronchitis and other cachexia?. 



558 THERAPEUTICS AND MATERIA MEDICA. 

What is the proportion of mercury in hydrargyrum cum 
creta? What is the dose? 

Thirty-eight per cent, mercury. Dose, y 2 to 10 grains. 

Compare the therapeutic uses of pepsin and pancreatin. 
How are these remedies prepared? 

Pepsin is the name for the hypothetical digestive principle 
of gastric juice. Pancreatin is a mixture of the enzymes 
naturally existing in the pancreas of warm-blooded animals. 
Pepsin is usually obtained from a solution prepared by di- 
gesting the mucus scraped from the rennet-bags of sheep or 
the stomach of the pig in acidulated water for several days. 
It is then precipitated by sodium chloride, lead acetate or 
alcohol. Pancreatin is usually obtained from the fresh pan- 
creas of the hog. Pepsin is employed in cases of gastric indi- 
gestion; while pancreatin is indicated in intestinal indigestion. 

Describe the therapeutic action of spigelia. What are 
its therapeutic uses? 

Spigelia, pink root, is anthelmintic against the round-worm 
and is usually administered with senna. In large doses it is 
an uncertain cathartic, and may produce serious symptoms, 
including vertigo, dimness of vision, dilated pupils and con- 
vulsions. 

What are the therapeutic uses of cannabis and what is 
the dose of the tincture of cannabis indica? 

It is used as a sedative and soporific as a substitute for 
opium in such conditions as chronic bronchitis, phthisis, in the 
dyspnea of asthma, and in the restlessness of chronic neph- 
ritis. As an analgesic it is useful in neuralgia and migraine. 
It is also employed in mania, delirium tremens, and in some 
forms of dysmenorrhea and menorrhagia. The dose of the 
tincture is 10 to 60 minims. 

What is the composition of hydrargyri iodidum rubrum? 

It is a red crystalline powder prepared by the double de- 
composition between potassium iodide, 5 parts, and mercuric 
chloride, 4 parts. 



THERAPEUTICS AND MATERIA MEDIC A. 559 

Where is the cinchona tree indigenous? What part of 
the tree is used in medicine? 

It is a native of the eastern slope of the Andes. The bark. 

Name three drugs used to retard the heart's action and 
state the dose of some preparation of each. 

Aconite, dose of the tincture, 1 to 3 minims; antimony, 
dose of tartar emetic 1-16 to 1 grain ; veratrum viride, dose of 
the tincture 3 to 6 drops. 

Describe the symptoms of hydrargyrism. 

The first symptoms of chronic mercurial poisoning are 
fetid breath, swollen and spongy gums having a bluish line 
along their margin, stomatitis, sore and loosened teeth, sali- 
vation. Anorexia, diarrhea and fever follow, also ulceration, 
and in some cases even gangrene of the lips and tongue. 
There is destruction of tissue and various nervous disturb- 
ances. The patient becomes emaciated, suffers from head- 
ache, insomnia, neuralgia and tremor, a vesicular or pustular 
eruption appears, and finally there follow coma and con- 
vulsions. 

Give the common name and state the physiologic effects 
of mentha piperita. 

Peppermint. It is an aromatic stimulant, also carmina- 
tive and anti-spasmodic. It is used in the form of menthol, 
as an antiseptic and local anesthetic. Peppermint is em- 
ployed internally for the relief of nausea and colic and as a 
carminative. It is an agreeable corrigent for combination 
with purgatives to prevent griping. 

Of what is iodoform a preparation and what is the dose 
for internal administration? 

Iodoform contains from 94 to 97 per cent, of iodine. Dose, 
1 to 5 grains. 

What are the sources of salicylic acid? 

. Salicylic acid is an organic acid existing naturally in com- 



560 THERAPEUTICS AND MATERIA ME DIG A. 

bination in various plants, but is generally prepared synthet- 
ically from carbolic acid. 

Give the source and describe the uses of lanolin. 

Lanolin is the purified fat of the wool of sheep mixed with 
not more than 30 per cent, of water. It is useful in chronic 
skin diseases where there is infiltration and where a pene- 
trative action is required for medicaments locally applied. 

How do oleates and ointments differ? 

Oleates are liquid solutions of metallic salts, or alkaloids 
in oleic acid intended for external administration. Oint- 
ments are soft, fatty mixtures of medicinal agents with a 
basis of lard, petrolatum, etc. They are intended for appli- 
cation to the skin by inunction, and have a melting point 
which is below the ordinary temperature of the human body. 

What are the therapeutic uses of acetanilid adminis= 
tered internally? Has it any uses when locally applied? 
If so, what are they? 

It is used internally as an antipyretic and an analgesic and 
anti-spasmodic. It is extensively employed in surgical prac- 
tice as a dry dressing for wounds, etc. 

Describe linum and give its medical preparations and 
uses. 

Flaxseed is the seed of linum usitatissimuni. It contains 
15 per cent, of mucilage in the epithelium, also 30 to 40 per 
cent, of fixed oil in the embryo. Linseed oil is official. Lin- 
seed tea is in common use, but is not official. Carron oil, a 
favorite application for burns, consists of equal parts of lin- 
seed oil and lime water. Linseed is demulcent, emollient, 
expectorant and diuretic. The oil is laxative in doses of 1 
ounce. The ground seed is used in making the linseed 
poultice. 

What are the symptoms of iodism? How may it be 
prevented while the use of the iodide is continued? 

The symptoms of iodism are anemia, emaciation and mental 



THERAPEUTICS AND MATERIA MEDIC A. 561 

depression. There is frontal headache, ptyalism, a saline 
taste in the mouth, dysphagia, temporary impotence and an 
eruption of acne on the face and limbs. The iodide of 
potash may be prescribed in combination with tincture of 
cinchona or with Fowler's solution, which prevents the iodic 
eruption to some extent. If the iodides are given freely 
diluted in water the toxic effects are less likely to be produced. 

Give the common name of hydrastis and describe its 
therapeutic uses. 

The common name is goldenseal. It is used chiefly as a 
stomachic tonic and antiperiodic, a mild laxative and an 
antiseptic. It is of value in catarrhal inflammation of the 
gastro-intestinal and genito -urinary tract and as a local alter- 
ative and antiseptic application. 

Write the following prescription by the metric system: 

Potassii bicarb. * 3^ dr. 

Acidi acetici • 7 fl. dr. 

Aquae 3 fi. oz. 

Potassii bicarb grammes 1 3.608 

Acidi acetici cubic c. c. 26. 

Aquae cubic c. c. 89. 

What are the possible dangers from the use of salol in 
large doses? 

Salol breaks up in the body into salicylic acid and carbolic 
acid. It is apt to produce the symptoms of carbolic acid 
poisoning. 

Give the medical name and the official preparation of 
lignum vitae. 

Guaiacum. The official preparations are the tincture of 
guiac and the ammoniated tincture. 

What are the therapeutic uses of manganese? 

The salts of manganese, especially the permanganate of 
potash, are used in anemia, in irregularities of menstruation, 
as an antidote against opium or morphine in the stomach and 
36 



562 THERAPEUTICS AND MATERIA MEDICA. 

locally, as an antiseptic and oxidizing agent. The dioxide 
is a good remedy in amenorrhea, gastrodynia and pyrosis, 
and in the form of an ointment for many skin diseases. 

How is the peroxide of hydrogen prepared? What are 
its therapeutic uses? 

The peroxide of hydrogen of commerce is the solution of 
hydrogen dioxide. It consists of water to which nascent 
oxygen has been presented, whereby an additional atom of 
the oxygen has entered into combination with the hydrogen, 
producing H 2 2 . This solution contains, when freshly pre- 
pared, 3 per cent, of the pure dioxide, corresponding to about 
10 volumes of available oxygen. This preparation is a non- 
toxic antiseptic. It is employed as a gargle or spray in 
quinsy, croup, diphtheria, scarlet fever, ozena, and for the 
purpose of cleansing wounds. It may possess some value as 
an intestinal antiseptic on account of the fact that it is a 
valuable oxidizing agent. 

What are the therapeutic uses of uva ursae? What part 
of this plant is used in medicine? 

Bearberry is an astringent tonic, and is feebly diuretic. 
The leaves are employed. 

What is the common name of oleum morrhuae? On 
what physiologic effect does its therapeutic use depend? 

Cod-liver oil. The action of cod-liver oil is like that of 
any other fat except that it is more easily assimilated than 
any member of the class. Its beneficial effects, therefore, 
are derived solely from its food value. 

What is the composition of linimentum calcis? For 
what is it principally used? 

Carron oil consists of equal parts of lime water and linseed 
oil, and is employed chiefly in burns. 

What action on the heart has valerian in full doses? 
State the therapeutic uses of valerian. 

In full doses it increases the action of the heart and raises 



THERAPEUTICS AND MATERIA MEDICA. 563 

the temperature. The oil in large doses lowers the blood 
pressure and slows the pulse. Valerian is used in hysteria, 
for the flatulence of infants and nervous subjects, also for 
coughs of nervous type, in whooping cough, diabetes insipi- 
dus and in delirium with vital depression. 

Where is jalap indigenous? What part of it is used in 
medicine? 

Jalap is a Mexican plant. The root is used. 

Mention the salts of silver used in medicine and give 
the dose of each. 

Silver nitrate, dose % to y 2 grain. Silver cyanide; this 
is not used in medicine except in the preparation of hydro- 
cyanic acid. Silver iodide, dose % to 1 grain. Silver oxide, 
dose y 2 to 2 grains. 

Describe the therapeutic uses of (a) water and (b) min= 
eral water. 

Cold water or ice has many external applications of value 
in the treatment of disease. As a wet pack it is used in ton- 
sillitis and diphtheria. The cold baths and the cold wet pack 
are the best methods of obtaining an antipyretic effect in 
fevers. Cold or ice water is applied to the head in acute 
cerebral congestion. Locally in orchitis, the uterus in post- 
partum hemorrhage. Hot water externally is most 
effective in reducing local congestion and setting up resolu- 
tion of local inflammation. The hot wet pack is highly es- 
teemed in inflammations of the chest. The vaginal hot-water 
douche is serviceable in catarrhal conditions of the vaginal 
and cervical mucous membrane and congestive, swollen or 
neuralgic conditions of the ovaries, tubes and adjacent tis- 
sues. Vapor and Turkish baths are used in chronic kidney 
disease and as diaphoretics generally wherever a diuretic 
effect is desired. Internally, water is of value as diuretic, 
and if hot as a diaphoretic. Mineral waters are esteemed 
most highly when they are of the class possessing aperient 
and purgative properties. Depending upon the composition 



564 THERAPEUTICS AND MATERIA MEDIC A. 

of these waters, they may be of value in chronic rheumatism, 
diabetes, obesity, syphilis, metallic poisoning, constipation, 
etc. 

Where is the cinnamon tree indigenous? Mention the 
active principle of cinnamon and give its dose. 

Ceylon. The active principle is a volatile oil, the dose of 
which is 10 to 20 grains. 

What therapeutic uses has chloroform other than an 
anesthetic? 

It is used in intestinal colic and serous diarrhea, as a car- 
minative and as a sedative in cases of obstinate cough. 

What is the dose of tincture of belladonna and what 
indications show that its physiologic effect has been ob= 
tained? 

Five to thirty minims. Medicinal doses quicken the pulse 
and large doses stimulate respiration. Dryness of the mucous 
membrane and skin and dilatation of the pupil will indicate 
the physiologic effect has been reached. 

For what purposes and effects is strychnia frequently 
used in formulae for cathartics? 

Strychnia stimulates the muscular coat of the intestine, 
increasing peristalsis, and thus acts. as a purgative, but it 
restrains the frequent discharges due to atony of the bowels. 

What effect has pilocarpus on (a) the heart, (b) the 
skin, (c) the salivary glands? 

(a) Pilocarpus is a cardiac depressant by stimulation of 
the vagus ends; (b) it causes prompt and profuse perspira- 
tion, and (c) salivation. 

What is the source from which eserin is obtained? 
How and for what purpose is eserin principally used? 

Eserin is one of the two alkaloids of physostigma. It is 
used locally in solution of 2 grains to the ounce in the eye to 
contract the pupil and reduce intra-ocular tension. Inter- 



THERAPEUTICS AND MATERIA MEDIC A. 565 

nally it is efficient in constipation due to torpor of the bowel, 
in which condition it is usually combined with belladonna 
and nux vomica. 

Describe the therapeutic uses and the dangers of chloral 
hydrate. How does a toxic dose of chloral hydrate affect 
body temperature? 

Chloral is chiefly used to promote sleep and to check spasms. 
It must be administered with care on account of the danger 
of the patient becoming addicted to the chloral habit. It is a 
distinctly dangerous drug, as it lowers the blood pressure and 
body temperature. Cardiac and respiratory weakness are 
contra-indications to its use. Toxic doses lower body tem- 
perature. 

What is the common name of guaiacum? What are the 
therapeutic uses of guaiacum? 

Its common name is lignum vita. Guaiacum is diaphoretic, 
expectorant and alterative, also laxative and purgative, ac- 
cording to the dose administered. 

What are the therapeutic uses of limonis succus? 

Lemon juice is used as a refrigerant and diuretic mixture 
in fever. For acidity of the stomach and as a common 
remedy in obesity. Locally it is used as an antipyretic, anti- 
pruritic and as a gargle. It is also used for flavoring pur- 
poses. 

Define anthelmintic and name the remedies of this class. 

Anthelmintics are agents which destroy or expel worms 
inhabiting the intestinal canal. They are classed according to 
the worm against which they are each most efficient. For 
thread worms the principal remedies are quassia, alum, sodium 
chloride, lime . water and the vegetable astringents. For 
round worm, santonin, spigelia, chenopodium. For tape 
worm, filix mas, kamala, kousso, pepo and granatum. The 
principal vermifuges are the purgatives, castor oil, jalap and 
scammony. 



566 THERAPEUTICS AND MATERIA MEDICA. 

What are the therapeutic uses of resorcin? 

Resorcin is employed as an antipyretic and antiseptic. A 
3 per cent, solution gives good results in ulcer of the stomach, 
cancer and other morbid conditions. It is also used locally as 
a remedy in skin diseases. 

Name the official preparation and state the therapeutic 
uses of santalum album. 

Oil of sandal wood is official. It is extensively used in 
chronic bronchitis and catarrhal conditions of the genito- 
urinary tract. 

How is collodium made? What are the preparations of 
collodium? 

Collodium is made by dissolving 3 parts of pyroxylin in 
75 parts of ether and 25 parts of alcohol. There are flexible 
collodium, styptic collodium and cantharidal collodium. 
Collodium is used as a protective covering for superficial 
burns, ulcers, wounds and slight cuts. Styptic collodium 
has many uses as a hemostatic and protective, while the 
cantharidal form is a convenient epispastic. 

Give the common name and the therapeutic uses of 
hematoxylon. 

Log- wood. Log-wood is mildly astringent, its properties 
depending upon the tannin contained in it. It is not irritat- 
ing, and is useful in diarrhea and hemorrhages in young 
children. It has been employed as a hemostatic in bleeding 
of the lungs and hemorrhages from the uterus and intestines, 
also as an astringent injection. 

On what physiologic action does the therapeutic use of 
elaterin depend? 

Elaterin is the most powerful of the hydragogue cathar- 
tics, causing profuse watery stools, and when given in large 
doses great prostration and gastro-intestinal irritation, nau- 
sea and vomiting. 



THERAPEUTICS AND MATERIA MEDIC A. 567 

State the source of ichthyol and give its uses in medi= 
cine. 

Ichthyol is prepared from the product of the distillation 
of bituminous rocks from the Tyrol, which contain fossil 
fishes. It is useful in certain chronic skin diseases, particu- 
larly eczema and psoriasis. It is extensively used externally 
for its antiseptic and alterative properties in rheumatism, 
erysipelas and lymphatic enlargements. Combined with gly- 
cerin, it is valuable, locally applied, in the various inflamma- 
tory affections of the female genital organs. 

What are the therapeutic uses of aconite? Give the 
dose of the fluid extract of this drug. 

Aconite is used locally in neuralgia; internally in hyper- 
emesis, in acute inflammation, such as tonsillitis, bronchitis 
and pneumonia, in excessive hypertrophy of the heart, in 
nervous palpation, in the tachycardia of exophthalmic goiter 
and in active cerebral congestion with high arterial tension. 

What part of scoparius is used in medicine? What 
alkaloid is derived from scoparius? 

The tops of cytisus scoparius. Its alkaloid is sparteine. 

Give the common name of taraxacum and state what 
part of this plant is used in medicine. 

Dandelion. The root is used in medicine. 

What is the physiologic action of tincture of the chlor= 
ide of iron upon the kidneys? 

The tincture of the chloride is considered diuretic. 

Give the chief source and the dose of gallic acid. 

It is prepared from a paste of powdered galls by ferment- 
ing for six weeks, boiling and reboiling in water, filtering and 
crystallizing. Dose, 5 to 15 grains. 

Give the dose of hyoscin for hypodermic use. For what 
purpose is hyoscin used? 

The dose of hyoscin hydrobromate hypodermically is 1-200 



568 THERAPEUTICS AND MATERIA MEDIC A. 

to 1-50 grain. Hyoscin is a cerebral and spinal sedative, a 
powerful hypnotic. It is employed as anodyne when 
opium is contra-indicated. 

What is an excipient? Give examples. 

Excipients are substances which give form and consistence 
to prescriptions, and serve as vehicles for the exhibition of 
the other ingredients. Examples are syrups, acacia and the 
various flavoring agents, such as syrup of lemon. 

Describe the technique of venesection. 

The patient having been placed in a semi-recumbent posi- 
tion, the arm should be constricted three or four inches above 
the elbow by a few turns of a roller or a twisted hankerchief ; 
if this is not sufficient to render the veins prominent, the arm 
may be rubbed for a few minutes from below upwards. A 
large vein having been selected, it should be incised by a 
thumb-lancet or a spring-lancet in a direction oblique to the 
long axis of the vessel. The amount of blood abstracted will 
depend entirely upon the pulse, which should be carefully 
observed during the operation, and when it lessens in force 
and becomes more compressible the bleeding must be sus- 
pended. 

Define glucosides and give two examples. 

Glucosides form a group of organic principles existing in 
plants, and are generally neutral in character. Examples 
are salicin, obtained from willow and other barks, and glycyr- 
rhizin, from liquorice root. 

What is the most active laxative ingredient in pulvis 
glycyrrhizae compositus? 

Senna. 

By what methods do antipyretics act? Give an example 
of one that acts by each method. 

Antipyretics reduce the body temperature in fever: (a) 
by lessening the production of heat; (1) by diminishing tis- 
sue change; (2) reducing the circulation, or (b) promoting 



THERAPEUTICS AND MATERIA MEDIC A. 569 

the loss of heat; by (3) dilating the cutaneous vessels; (4) 
producing perspiration and (5) abstracting heat from the 
body. Examples of antipyretics acting in the order named 
are as follows: Quinine (1), digitalis (2), carbolic acid (1 and 
3), antipyrin (1 and 4), cold sponging (5). 

Indicate the common name and give the preparations of 
serpentaria. 

Virginia snake-root. The preparations are the fluid ex- 
tract and the tincture. It also is one of the components of 
compound tincture of cinchona. 

What are the therapeutic uses and the official prepara= 
tions of oleic acid? 

Oleic acid is used only in making the oleates. Three 
preparations are official, the oleate of mercury, the oleate of 
veratrine and the oleate of zinc. 

What is the antidote for strychnine? 

Chloral hydrate. 

Describe the manner of making barley water as food 
for the patient. 

It may be made as follows : Grind % ounce of pearl barley 
in a coffee mill, add 6 ounces of water, boil 20 minutes, add 
salt and strain. 

What are the therapeutic uses of the preparations of 
silver? 

The nitrate is the most soluble of the silver salts; it is 
antiseptic, astringent, hemostatic, irritant, and a limited es- 
charotic, also anti-phlogistic, anti-spasmodic and tonic. The 
oxide is the least irritant, and does not discolor the skin so 
quickly. Internally it has been used in gastric neuralgia, 
irritable dyspepsia, pyrosis, gastric and pulmonary hemor- 
rhages, dysmenorrhea, menorrhagia, to check profuse sweat- 
ing, to control vomiting, and in diarrhea depending on reflex 
nervous irritation. The iodide is similarly employed. 



570 THERAPEUTICS AND MATERIA MEDIC A. 

How would you distinguish chemically between ether 
and chloroform? 

Ether is ethyl oxide (C 2 H 5 ) 2 0. In its absolute form it is 
not official, the strongest preparation containing 4 per cent, 
of alcohol and some water. Chloroform is the true chloride 
of methyl, CHC1. 

Name four drugs used in the treatment of chronic inter= 
stitial nephritis. 

Nitroglycerin, Basham's mixture, caffein and magnesium 
sulphate. 

Give the therapeutic uses of caffein. 

Cardiac stimulant in cardiac and renal dropsy, and alone 
or in combination with antipyrin or the bromides in nervous 
headache and migraine. 

Describe the physiologic action of aconite. 

It is a powerful depressant of the sensory nerve ends, the 
nervous and muscular apparatus of the heart and respiration, 
and the spinal nervous system. It is also antipyretic, dia- 
phoretic and diuretic. 

Name the official preparations and doses of digitalis, 
cascara sagrada and ipecacuanha. 

Digitalis, the extract, dose % to % grain, the fluid extract 
1 to 2 drops, the infusion 1 to 4 drams, the tincture 5 to 20 
drops. Cascara sagrada, the fluid extract, dose % to 1 dram. 
Ipecacuanha, the fluid extract, emetic dose 20 minims, 
Dover's powder 5 to 10 grains, the syrup emetic dose 4 to 6 
drams, troches, each contain % grain, troches of morphine 
and ipecac, contain 1-36 grain morphia, 1-12 grain ipecac, 
wine of ipecac, emetic dose 4 to 6 drams. 

Name four efficient hypnotics and give the source and 
dose of each. 

Sulphate of morphine derived from opium, dose % to % 
grain; hyoscine, the alkaloid of hyoscyamus, dose of the ex- 
tract y 2 to 2 grains ; chloral hydrate obtained from the union 



THERAPEUTICS AND MATERIA MEDIC A. 571 

of water with, trichlor-aldehyde, dose 10 to 20 grains; sul- 
phonal, a synthetic product obtained by the oxidation of a 
mixture of ethyl-mercaptan and acetone, dose 15 to 30 grains. 

Write a prescription for (a) a collyrium, (b) a supposi= 
tory, and (c) a mouth=wash. 

( a ) B . Acidi borici gr. x 

Aquse camphorse 

Aquae destillatse aa q. s. ad f # ^j 

Sig. — Fifteen drops in both eyes thrice daily. 

( b ) R . Pulveris opii gr. j 

Iodoformi gr. j 

Olei theobrom. q. s. 
Fr. in suppositoria No. 1. 
Sig. — Use on retiring. 

( c ) R . Potassii chloratis. gr. Ixxx 

Aqua? laurocerasi f 3 viij 

M. S. — Use as mouth- wash. 

Name five antiseptics and tell in what proportions each 
should be diluted for surgical purposes. 

Bichloride of mercury, 1 to 1000. Permanganate of pot- 
ash, 25 grains to the pint. Boric acid, 15 grains to the ounce. 
Carbolic acid, 5 per cent, solution in glycerine and water. 
Peroxide of hydrogen, the full strength of the official prepa- 
ration is 3 per cent. 

Describe the physiologic action of hyoscin and name a 
physiologic antidote. 

It is a cerebral and spinal sedative and powerful hypnotic, 
directly depressing the higher function of the brain and 
affecting the heart but feebly. Tannin and morphine. 

Give the composition of the official compound cathartic 
pill. 

Compound extract of colocynth, 130 grains; extract of 
jalap, 100 grains; mild chloride of mercury, 100 grains; 
gamboge, 25 grains. These quantities properly prepared 
make 100 pills. 



572 THERAPEUTICS AND MATERIA MEDICA. 

Describe two escharotics and tell how you would apply 
them. 

Nitrate of silver applied in the form of lunar caustic is an 
efficient superficial eseharotic ; carbolic acid is escharotie, and 
should be used in strong solution, 1 to 10. 

Write a correct prescription containing nitrate of silver. 

Argenti nitratis gr. iij 

Gum Tragacanth, q. s. 

Ft. — In pil. no. xii. 

Sig. — One before meals. John Jones, M. D. 

State the direct and indirect effect of pilocarpine in 
dropsical effusion. 

It causes prompt and profuse perspiration and salivation, 
increases the bronchial and lachrymal secretion, and some- 
times causes serous diarrhea. Full doses cause a decrease 
in arterial tension. The elimination of urea is greatly in- 
creased, but not the quantity of the urine. 

What are the physiological effects of nux vomica on the 
nerves and circulatory system? 

It is a powerful stimulant of the spinal cord, especially the 
motor columns. In toxic doses it produces spinal convulsions. 
Small amounts stimulate the brain and increase the mental 
powers. In moderate doses the heart is stimulated and the 
arterial pressure raised by stimulation of the vasomotor cen- 
ter in the medulla. 

What is wrong with the following prescription? 

R . Argentse nitratis drams, one. 

Sodi chloridum drams, four. 

Syrupus lemonis, q. s. ounces, four. 

Sig. — Take a tablespoonful after meals in water. 

Argentce should read argenti; sodi chloridum should read 
sodii chloridi; syrupus lemonis should read syrupus limonis. 
This prescription affords the example of a pharmaceutical 
incompatibility. Nitrate of silver should not be compounded 



THERAPEUTICS AND MATERIA MEDICA. 573 

with sodium chloride, for there results the insoluble chloride 
of silver. 

Write for an adult a complete prescription for a diarrhea 
mixture containing three remedies and the excipient. 

R Cretse preparatse 5 ii 

Tincturse catechu 3 ss 

Tincture opii rrijxxx 

Aqua cinnamomi ad f ^ viii 

M. Sig. — Two teaspoonfuls every four hours. 

Name the official preparations of belladonna and the 
dose of those used internally. 

Extractum belladonna foliorum alcoholicum. Dose 1-12 to 
14 grain; tinctura belladonna foliorum, dose 5 to 30 min. ; 
extractum belladonna radicis fluidum, 1 to 2 min. ; emplas- 
trum belladonna; unguentum belladonna. 

Write a prescription containing oil of sandal wood and 
at least one other constituent for chronic cystitis. 

January 1, 1903. For William Smith. 

R. Olei santali f|i 

Salol 3 i 

Ft. in Capsules no. xii. 

Sig. — One after meals. Wm. Jones, M. D. 

Define narcotics, anesthetics and sedatives, and give an 
example of each. 

Narcotics are agents which lessen pain and produce sleep 
or stupor; example, opium. Anesthetics are agents which 
temporarily destroy sensation ; they are both general and 
local; example, ether as a general anesthetic and chloride of 
ethyl as a local anesthetic. Sedatives are agents which exert 
a soothing influence on the system by lessening functional 
activity, depressing motility and diminishing pain; example, 
the bromides. 

Treat a case of opium poisoning; also give the thera= 
peutic uses of opium. 

The stomach should be emptied by the stomach pump or a 



574 THERAPEUTICS AND MATERIA MEDICA. 

stimulating emetic, like sulphate of zinc or mustard. Pre- 
vious to this, however, if the opium is in the stomach, solution 
of permanganate of potash should be administered f ree]y ; as 
a chemical antidote strong coffee should be given, and the 
patient should be aroused by flagellation, douching, or forced 
walking. Atropine and strychnine should be given hypoder- 
mically. The temperature should be maintained by the ex- 
ternal application of heat. In therapeutics Opium is used 
internally to produce sleep, to relieve pain, to lessen nervous 
excitement, to promote diaphoresis, to check hemorrhage and 
to support the system. Externally it is used as a sedative. 

Name five emetics and give the dose of each. 

Alum, dose, 1 to 4 drams; mustard, dose, 1 to 4 drams; 
ipecac, dose, of the fluid extract, 15 to 30 minims; apomor- 
phine, dose, 1-10 to 1-5 grain ; sulphate of zinc, dose, 10 to 30 
grains. 

What are the advantages and disadvantages in the use 
of chloroform as an anesthetic and what are the signs in= 
dicative of danger in the patient? 

Inhalations of chloroform produce sensations which are 
rather agreeable than otherwise, while the first stage of ether 
anesthesia is decidedly unpleasant. Chloroform produces 
anesthesia more quickly than ether, and in certain cases this 
is an advantage. It is, however, much more dangerous than 
ether. Its dangerous symptoms are: (1) respiration becomes 
stertorous or shallow, (2) sudden dilatation of the pupils, (3) 
signs of cardiac failure. Chloroform produces much less 
subsequent vomiting. 

Define briefly but clearly serum therapy. 

Serum therapy properly means the prophylactic and cura- 
tive treatment of certain acute infectious diseases by the sub- 
cutaneous injection of a blood serum containing an antitoxin 
specific to the particular disease. As generally used, how- 
ever, this term includes the treatment of the same disorders 
by the toxins produced by attenuated cultures of their re- 



THERAPEUTICS AND MATERIA MEDIC A. 575 

spective microbes; but these toxins, though, sometimes grown 
on blood serum, may be cultivated on other media, and are 
never administered in a serum, as the antitoxins invariably 
are. The antitoxins at present employed in serum therapy 
are those of diphtheria, tetanus, tuberculosis, erysipelas, pneu- 
monia, cholera, syphilis, plague and typhoid fever, but only 
the first three have come into anything like general" use. 
(Potter.) 
What official preparations are derived from the willow? 

Salicin is a glucoside obtained from several species of the 
willow. The various salicylates are prepared from salicin as 
well as salicylic acid. The salix nigra is the source of the 
fluid extract of this willow which is on the market. 

What active principles are found in digitalis? What 
are the official preparations of petroleum? 

Digitalin, digit oxiw, digitalein, digit onin and digitin. Pe- 
trolatum is a mixture of the hydrocarbons obtained from 
petroleum. The official preparations are petrolatum li- 
quidum, petrolatum molle and petrolatum spissum. 

Give the physiologic action and therapy of saline pur= 
gatives. 

This group includes the neutral salts of metals of the alka- 
line or alkaline earths. They stimulate the intestinal glands 
to increased secretion, and by their low diffusibility impede 
re-absorption, causing an accumulation of fluid in the intes- 
tinal tract. This, partly from the effect of gravity and partly 
by gentle stimulation of peristalsis excited by distension, 
reaches the rectum and produces a copious evacuation. Mag- 
nesium sulphate and sodium sulphate are the typical salines. 
They should be given in plenty of water and during active 
movement (as in walking) in order to produce their best 
effects. 

Name three drugs used in the treatment of intermittent 
fever. State how each controls this disease. 

Quinine exerts a specific influence in all malarial infections 



576 THERAPEUTICS AND MATERIA MEDIC A. 

by reason of its power to prevent the development of the 
Plasmodium to which malaria is due. A 10-grain dose of the 
sulphate should be given in the sweating stage, and again five 
hours before the expected time of the next paroxysm. In the 
intervals arsenic is of more value; its therapeutic action is 
due to the fact that it is a valuable anti-periodic, as well as 
tonic and alterative. Mercury is also of value for its hema- 
tinic and alterative properties. 

Describe the treatment of intestinal indigestion. 

Under this term a variety of conditions have been described 
dependent upon various causes, but it is usually restricted to 
acute or chronic intestinal catarrh. When this is dependent 
upon causes residing in the stomach the existing gastritis must 
be first treated. A course of calomel and soda is of value; 
this may be followed by the administration of pancreatin, 
which will aid digestion. Proper measures of diet and exer- 
cise are important. Charcoal in 10-20-grain doses is useful. 

Name four drugs incompatible with tannic acid. Name 
two incompatible with hyoscyamus. 

Tartar emetic, lead acetate, silver nitrate and hydrochloric 
acid are incompatible. The hydroxid of potassium with tan- 
nin and sodium with hyoscyamus. 

What doses of antitoxin are used for a child five years 
old ill with diphtheria? What would be the prophylactic 
dose for the same child? 

1500 units. 500 units.' 

Correct the following prescription: 

R . Atropiae Sulphati. grs. iss 

Potas. Iodidi J oz. 

Infusae Digitalis- £ fl. oz. 

Elix. Simpl. q. s. ad 2 fl. oz. 

M. S. — Teaspoonful in water four times a day. 

Potassium iodide is best given alone. The dose of atropine 
is much too great. It should be about 1-100 grain to each 
dram. Atropi® sulphati should read Atropine? sulphatis. 
In the last drug Infusce should read Infusi. 



THERAPEUTICS AND MATERIA MEDICA. 577 

Name three drugs incompatible with belladonna and two 
incompatible with pilocarpine. 

The hydroxids of potassium, sodium and lithium are in- 
compatible with belladonna, and these are also incompatible 
with pilocarpine, as are the salts of the metals generally. 

Give the usual dose of creosote and tell how it is best 
administered. 

It is prescribed in 1 to 5 minim doses, well diluted in wine 
or whiskey. 

Name four official pills and give the principal ingre= 
dients of each. 

Pills with aloes contain purified aloes and powdered soap ; 
pills of asafetida contain asaf etida and powdered soap ; com- 
pound pills of iron contain myrrh, carbonate of sodium, sul- 
phate of iron and syrup ; compound rhubarb pills contain 
rhubarb, aloes, myrrh and oil of peppermint. 

Define tinctures, extracts and ointments and tell as a 
rule how many drops of a tincture are in a fluid dram. 

Tinctures are alcoholic solutions of medicinal substances, 
and with the exception of tincture of iodine are made from 
non-volatile bodies. Extracts are solid or semi-solid prepa- 
rations obtained by evaporating solutions of vegetable prin- 
ciples. Ointments are soft, fatty mixtures of drugs with a 
basis of lard, petroleum or fixed oils. The number of drops 
to a fluid dram of tinctures varies widely; 110 may be con- 
sidered an average. 

Write a complete prescription containing at least three 
drugs for acute bronchitis in an adult. Use no abbrevia= 
tions. 

January 1, 1903. For Mrs. Watson. 

R . Tincturse opii camphorata f "g v 

Tincturae nucis vomicae f % ii 

M isturse glycyrrhizae composite f 3 iv 

M. S — Teaspoonful every four hours. John Jones, M. D. 

37 



578 THERAPEUTICS AND MATERIA MEDIC A. 

In the treatment of syphilitic node or gumma state 
which should be used, a mercurial or an iodide, and give 
the reason therefor. 

In the treatment of the tertiary lesions of syphilis the 
iodides and mercury, the so-called mixed treatment, is often 
employed, the object being to get the greatest possible alter- 
ative effect. The appearance of a gumma, especially of the 
nervous system, demands energetic drug treatment. Iodides 
should be given in the largest possible doses, and mercury 
should be administered by inunction. 

Give the reason which would determine the employment 
of a vegetable or a mineral astringent in acute inflam= 
matory conditions. 

Vegetable astringents check secretion and hemorrhages and 
cut short local inflammation. They are practically non-toxic. 

Differentiate the conditions in which opium and hyoscine 
should be used to promote sleep. 

Hyoscine is useful as a hypnotic in children, and in general 
in conditions in which opium is contra-indicated. Children 
are particularly susceptible to opium, and an opium habitue 
would require a different hypnotic. 

State when calomel or podophyllum should be given and 
give the reason for the selection. 

Calomel is unirritating, and has also a diuretic effect. 
Podophyllum is more irritating and causes more griping, 
and is to be selected in cases of habitual constipation. 

Name the coal=tar products used to reduce temperature. 

Their name is legion. Those in general use are antipyrin, 
phenacetin, acetanilid. 

Describe the alkaloid, strychnia, and give a test for de= 
termining its presence. 

Strychnia is an alkaloid derived from the seed of strychnos 
nux vomica, a tree of the natural order Loganiaceas, growing 
in India and China. Strychnia and its salts dissolve without 



THERAPEUTICS AND MATERIA MEDICA. 579 

color in concentrated sulphuric acid, but on adding to the 
solution lead peroxide a beautiful blue color results, passing 
into violet, then red, and finally yellow. 

What are the derivatives of cinchona and their doses? 

Cinchona bark contains 21 natural alkaloids, of which 4 
are official, quinine, quinidine, cinchonine and cinchonidine. 
The sulphates of these alkaloids may be administered in the 
following doses : 2 to 20 grains, 1 to 30 grains, 5 to 30 grains, 
1 to 20 grains. 

Describe four diuretics and give the dose of each. 

Potassium citrate occurs in transparent crystals, is odor- 
less, of cooling saline taste and a neutral reaction, dose 5 to 
30 grains. Spartein sulphate, the alkaloid of scoparius, oc- 
curs in white prismatic crystals of slightly saline and bitter 
taste, dose Vo to 2 grains. Digitalis (elsewhere described), 
dose of the tincture 10 minims. Calomel, the mild chloride 
of mercury, is efficient as a diuretic in % grain doses every 
hour. 

How does a lethal dose of gelsemium affect the system? 

In toxic doses it produces vertigo, diplopia, drooped eye- 
lids, dilated pupils, labored respiration, slow and feeble 
heart, dropped jaw, staggering gait, extreme muscle weak- 
ness, almost complete anesthesia, and death by asphyxia. 

Name three indications for the use of opium. 

To relieve pain, to produce sleep, to check excessive secre- 
tion, as in dysentery. 

How does opium act when used as in the last question? 

The principal action of opium is on the nervous system, 
first affecting the cerebral convolutions, which are briefly 
stimulated and soon depressed; next the perceptive and sen- 
sory centers in the higher brain are blunted and the con- 
ductivity of the afferent nerves is impaired. The hypnotic 
action of opium is believed to be due to the lessened activity 
produced by the drug on the nerve cells and the consequently 



580 THERAPEUTICS AND MATERIA MEDIC A. 

lessened demand for blood. Its constipating action is pro- 
duced by stimulation of the inhibitory nerves of the intestine 
through the splanchnic. 

What are the therapeutic uses of the preparations of 
bismuth? 

Locally the insoluble bismuth salts are used in acne rosa- 
cea, stomatitis, coryza, gonorrhea and leUcorrhea. The sub- 
nitrate is regarded as of great value in diarrhea and dysen- 
tery, in disordered digestion, vomiting, gastralgia and gastric 
ulcer. The bismuth nitrate is soluble and toxic, and is not 
generally used. The subcarbonate and the subgallate are used 
in the same class of cases as the subnitrate. 

How would you distinguish quinine from the other cin= 
chona alkaloids? 

The slight solubility of the sulphate of quinine in water 
distinguishes this alkaloid from other cinchona alkaloids. 

Give the adult dose of phosphorus, arsenious acid and 
tincture of aconite. 

1-100 grain; 1-50 grain; 1 to 3 minims. 

What condition of the eye contra=indicates the use of 
mydriatics? 

All diseases increasing intra-ocular tension. 

Describe the physiologic action of arsenic and name 
three indications for its use. 

In therapeutic dose, with the exception of a slight increase 
in the pulse, arsenic exerts very little influence on the circu- 
lation. In toxic dose it causes the fall of blood-pressure. In 
medicinal dose it is a cerebro-spinal stimulant, but in toxic 
closes it paralyzes the spinal cord, especially the sensory side. 
Small doses increase the appetite and stimulate digestion. 
Toxic doses produce violent gastro-intestinal inflammation. 
In small doses it diminishes and in large doses increases tissue 
waste. In concentrated form it is a powerful irritant and 
escharotic. It is indicated in anemia, malaria and diabetes. 



THERAPEUTICS AND MATERIA MEDIC A. 581 

Describe and give the indications for the uses of cardiac 
sedatives, with an example. 

Cardiac sedatives are drugs which are used to decrease the 
activity of the circulation. The indications for their use are 
increased arterial excitement, splenic fevers and severe local 
inflammation. Aconite is an example of such a drug. It 
reduces very markedly the rate of the pulse and the arterial 
pressure. 

Describe the physiologic action of antipyrin in medicinal 
doses on the circulation and temperature. 

After the ingestion of a full medicinal dose there is a stim- 
ulant stage, in which the heart's activity is increased; this is 
soon followed by profuse sweating, coolness of the surface, 
slowed pulse, considerable depression, and if fever be present 
by lowered temperature. In health it has very slight anti- 
pyretic effect. It raises the arterial tension and blood pres- 
sure. 

How do digitalis and belladonna act in increasing blood 
pressure? 

Digitalis increases blood pressure by its powerful stimu- 
lating effect on the heart by contraction of the arterioles, 
resulting indirectly from stimulation of the vasomotor center, 
and directly from the action of the drug on the vessel wall. 
The increased blood-pressure produced by belladonna is due 
to stimulation of the vasomotor centers and the heart itself. 

Name a vasomotor stimulant, a vasomotor depressant 
and describe the physiologic action of each. 

Belladonna is a vasomotor stimulant; it quickens the pulse 
and raises arterial pressure. The increased blood-pressure 
is due to stimulation of the vasomotor center and the heart 
itself. Toxic doses paralyze the heart; large doses stimulate 
the respiratory center; toxic doses paralyze it; large doses 
stimulate the brain and spinal cord and act as a depressant 
to the motor and sensory nerves; it lessens nearly all of the 
secretions except that of the kidney; it dilates the pupil by 



582 THERAPEUTICS AND MATERIA MEDICA. 

paralyzing the peripheral ends of the oculo-motor nerves 
and by stimulating the ends of the sympathetic. Veratrum 
viride is a vasomotor depressant; it lessens in a marked de- 
gree the force and rate of the cardiac pulsation; the lowered 
arterial tension results from depression of the vasomotor cen- 
ter and of the heart itself; the slowing of the pulse from 
stimulation of the inhibitory nerves of the heart and from 
weakening of the cardiac muscles. Large doses depress the 
respiratory center, the spinal cord and peripheral nerves and 
muscles. 

Give the theory of the alkaline treatment of rheuma= 
tism. 

The alkaline treatment of rheumatism by the administra- 
tion of potassium acetate, citrate, etc., was in general use 
before the introduction of the salicylates. Wood states that 
the alkalies do good in rheumatism by lowering arterial ac- 
tion, by favoring oxidation and elimination of partially effete 
products, and by neutralizing excessive acidity. 

What is incompatibility in medicine, and what are the 
different kinds of incompatibles? Give an example of 
each. 

Incompatibility in medicine signifies that a combination is 
not suitable for administration. Incompatibility may be 
chemical, pharmaceutical and therapeutic, according as the 
prescribed combination results in chemical decomposition, 
physical disassociation or antagonistic action. An example 
of chemical incompatibility is seen in the prescribing of qui- 
nine sulphate with potassium acetate, resulting in a volu- 
minous precipitate of quinine acetate. An instance of phar- 
maceutical incompatibility is the addition of an acid to a 
quinine and liquorice mixture, resulting in precipitation of 
the glycyrrhizin, relied on to cover the taste of the quinine by 
the acid. Therapeutic incompatibility rises when two agents 
are mixed together when they oppose each other in their ac- 
tion, for instance belladonna and physostigma. 



THERAPEUTICS AND MATERIA MEDIC A. 583 

Describe the physiologic action of salicylic acid. 

Salicylic acid is a powerful antipyretic and antiseptic. In 
small doses it stimulates the stomach, heart and respiration, 
but moderate quantities derange the stomach, causing nausea 
and vomiting, while large doses depress the heart's action 
and the respiration, lower the arterial tension, relax the ves- 
sels and produce free perspiration. 

Name the therapeutic uses of apomorphia and state how 
codeia differs in its physiologic action from morphia. 

Apomorphia is a valuable emetic and a useful expectorant 
in the dry stage of acute bronchitis, and in chronic bronchitis 
when the expectoration is viscid and scanty. While codeia 
possesses but feeble hypnotic powers, it exerts a sedative influ- 
ence similar to morphine ; it is at times much better borne by 
patients than morphine, but is regarded as less reliable. 

Enumerate the symptoms arising from a toxic dose of 
digitalis. 

Digitalis poisoning is characterized by obstinate vomiting, 
diarrhea, headache, severe pain in the back and limbs and a 
very slow, full pulse, which, when the patient sits up, may 
become rapid and feeble. Later, even in recumbency, the 
pulse becomes rapid, thready and irregular, the surface cold, 
the urine suppressed and the mind stuporous. Intelligence, 
however, is not lost until shortly before death. Occasionally 
convulsions develop during the last stage. 

What are the therapeutic uses of tartar emetic? 

It is employed as an emetic, diaphoretic, sedative, expecto- 
rant, cardiac depressant and counter-irritant. 

Describe cantharis and name four official preparations. 

Cantharis is the dried body of the beetle, Cantharis vesica- 
toria, found chiefly in the south of Europe. The active prin- 
ciple is cantharidin. Ceratrum cantharidis, collodium can- 
tharidatum, emplastrum picis cantharidatum, tinctura 
cantharidis. 



584 THERAPEUTICS AND MATERIA MEDICA. 

By what rule would you determine the dose of any medi= 
cine for a child? 

Young's rule will be found the most convenient. Add 12 
to the age and divide by the age, to get the denominator of a 
fraction, the numerator of which is 1 ; thus, for a child 2 years 
old, 2 plus 12 divided by 2 equals 7, and the dose is 1-7 of that 
for an adult. 

Name ten official preparations of mercury. Name four 
alkaloids of opium. 

Hydrargyrum cum creta, massa hydrargyri, unguentum 
hydrargyri, emplastrum hydrargyri, hydrargyri chloridum 
mite, hydrargyrum ammoniatum, unguentum hydrargyri 
ammoniati, hydrargyri oxidum navum, unguentum hydrar- 
gyri oxidi flavi, hydrargyri oxidum rubrum. The four alka- 
loids of opium are morphine, codeine, thebaine and narcotine. 

Give the source and dose of picrotoxin, creosote and pix 
liquida. 

Picrotoxin is a neutral principle derived from cocculus 
indicus, dose 1-100 to 1-20 grain. Creosote is a product ob- 
tained from distillation of wood-tar, dose 1 to 5 minims. 
Pix liquida, tar, is an oleoresin obtained from the destructive 
distillation of certain species of Pinus; the dose is 5 to 
10 grains. 

What are the principal therapeutic uses of the prepara- 
tions of mercury? 

The plaster of mercury is used as an absorbent and counter- 
irritant over chronic inflammatory swelling, glandular en- 
largements, syphilitic nodes, etc. Mercurial ointment and 
the oleate of mercury are used for the same purposes as the 
plaster; they are also extensively employed in the treatment 
of syphilis by inunction. Blue mass is used as a cholagogue, 
laxative and diuretic. Ammoniated mercury is used exter- 
nally as a stimulant or parasiticide. The chloride of mer- 
cury is an antiseptic, anti-parasitic, anti-syphilitic and ab- 
sorbent, and a tonic. The mild chloride, calomel, is used 



THERAPEUTICS AND MATERIA MEDICA. 585 

internally as an anti-syphilitic, as a laxative, as a gastric 
sedative, a cholagogue and a diuretic, and externally as a 
stimulant and desiccant. Mercury and chalk is used in the 
same class of cases as calomel. The yellow iodide is fre- 
quently used as a substitute for the chloride, as is the red 
iodide. The nitrate is used externally as a powerful caustic. 
The oxide is used externally for its stimulant and alterative 
effect. The yellow sulphate, turpeth mineral, is sometimes 
employed as a stimulating emetic for children, but it is dis- 
tinctly poisonous. 

State the contraindications to the use of quinine. 

It is contra-indicated in acute inflammatory affections of 
the brain, eyes and ears. 

In what form would you prescribe eucalyptus and in 
what doses? Whence is eucalyptus obtained? 

Eucalyptus is derived from the leaves of the tree Euca- 
lyptus globulus, a native of Australia. It may be prescribed 
in 10 drops to 1 dram doses of the fluid extract or in 5 to 30 
minim doses of the oil in elastic capsules or emulsion. 

In what strength would you use solutions of nitrate of 
silver, borax, permanganate of potash, bichloride of mer= 
cury and creolin for injection into the bladder? 

Silver nitrate, 1 grain in 4 ounces of water ; borax, 10 grains 
to the ounce; permanganate of potassium, 20 grains to the 
pint; bichloride of mercury, 1 to 3000; creolin, y 2 to 1 per- 
cent. 

Name six drugs containing large quantities of tannic 
acid. 

Galla, catechu, hamamelis, kino, granatum, hematoxylon. 

Name four drugs incompatible with iodide of potassium, 
two with atropine and one with antipyrin. 

Potassium iodide decomposes most of the metallic salts. 
The following four drugs are examples of this incompati- 
bility: Sulphate of quinine, sulphate of iron, acetate of lead, 



586 THERAPEUTICS AND MATERIA MEDICA. 

oxide of zinc. Physostigmine and aconite are incompatible 
with atropine. Tannic acid is incompatible with antipyrin. 

Give the physiologic action of ergot and mention its 
therapeutic uses. 

Ergot is a motor excitant and a vascular contractor. It is 
also hemostatic and anhydrotic, emmenagogue and oxytocic. 
It increases the functional activity of the spinal cord, it stim- 
ulates the vasomotor center, raises the blood-pressure, pro- 
duces contraction of unstriped muscle fiber, reduces the cali- 
bre of the arterioles, depresses the motor ganglia of the heart 
and causes a slower and weaker pulsation. 

Ergot is used to promote uterine contractions in labor, in 
amenorrhea due to plethora and in the atonic form of sper- 
matorrhea. It is useful in catarrhal inflammations of the 
mucous membranes generally. It is an excellent remedy in 
chronic diarrhea and dysentery, in hemorrhages of arterial 
type, in headache and migraine of congestive form, in mye- 
litis and tabes and chronic nervous diseases. It is also used 
locally in hemorrhages. 

Name four drugs used in the treatment of bronchorrhea 
and explain their action. 

Eucalyptus for its expectorant effect. Lead acetate for its 
astringent effect to restrict secretions. Quinine and arsenic 
as valuable tonics and restoratives. 

What is the physiologic action of rhubarb in dose of i 
to 5 grains? In dose of 30 to 60 grains? 

In small doses its action is that of a gastric tonic and an 
intestinal astringent. In larger doses its cathartic action 
prevails, producing in 6 to 8 hours copious yellow stools with 
some griping and considerable hepatic stimulation. 

For what purposes is diaphoresis produced? Name 
three diaphoretics. 

Diaphoretics are employed in medicine to fulfil the follow- 
ing indications: (1) to arrest forming diseases of not very 



THERAPEUTICS AND MATERIA MEDICA. 587 

severe type, as in general cold and suppressed menstruation; 
(2) to favor absorption, as in dropsy; (3) to aid in the sub- 
sidence of diseases which naturally pass off in a sweat, as 
malaria; (4) to eliminate noxious materials from the blood. 
Three excellent diaphoretics are pilocarpus, spirit of nitrous 
ether and Dover's powder. 

What is the source and what are the therapeutic uses of 
picrotoxin? 

Picrotoxin is a poisonous neutral principle obtained from 
the seeds of cocculus indicus, used in the night sweats of 
phthisis and in the form of an ointment as an anti-parasitic. 

Give the chemical name and the dose of (a) Epsom salts, 
(b) Rochelle salts, (c) Glauber's salts. 

(a) Magnesium sulphate, dose 1 dram to 1 ounce; (b) 
potassium and sodium tartrate, dose y 2 to 2 ounces; (c) so- 
dium sulphate, dose 1 dram to % ounce. 

Describe hypodermoclysis and state the circumstances 
under which it is practiced as a therapeutic measure. 

Hypodermoclysis is the introduction into the subcutaneous 
tissue of fluids in large quantity. It is indicated to replace 
the fluid lost through excessive purging or hemorrhage. It 
may also be used to wash from the body certain impurities 
circulating in the blood and lymph ; in other instances it may 
be used to supply the body with liquid when the stomach will 
not permit drinks to be swallowed, as in gastric ulcer or 
abdominal operations. Normal saline solution is used for 
such injections. The sterilized liquid is placed in a proper 
vessel which is absolutely aseptic, and to which air gains ac- 
cess only by means of a glass tube filled with sterilized cotton ; 
from the lower part of the vessel a rubber tube leads, to 
which is attached a canula carefully sterilized. The skin 
over the place where the liquid is to enter is to be rendered 
sterile. The trocar is then inserted into the subcutaneous 
tissue of the abdomen or thigh and the solution allowed to flow 
at the rate of 1 dram to each pound of body weight in 15 



588 THERAPEUTICS AND MATERIA MEDIC A. 

minutes. The pressure is obtained by raising the container a 
few feet. 

Define galactagogue and sialagogue and give an example 
of each. 

A galactagogue is an agent which increases the secretion of 
milk, example pilocarpus. A sialagogue increases the secre- 
tion and flow of saliva and buccal mucus, example mercury. 

By what process and from what source is sugar of milk 
principally obtained? 

It is a peculiar crystalline sugar obtained from the whey 
of cows' milk by evaporation and purified by recrystallization. 

State the source and give the uses of saccharin. 

It is a sweet amide derived from a coal-tar product, toluene. 
It is about 500 times sweeter than sugar; it is used as a sub- 
stitute for sugar in the food of diabetics and subjects of liver 
disease and corpulence. 

Describe the preparation of lime water. Give the offi= 
cial name and the adult dose. 

Liquor calcis may be given to an adult in doses of y 2 to 4 
ounces. It may be prepared by pouring 2 quarts of hot water 
over fresh unslaked lime the size of a walnut; stir till slaked, 
let it stand until clear and bottle. 

Give the source, the physiologic action and the thera- 
peutic uses of oleum ricini. 

Castor oil is a fixed oil expressed from the seeds of ricinus 
communis. It acts as a mild, but rather slow purgative, pro- 
ducing without irritation copious semi-liquid stools. It does 
not increase the flow of bile nor to a great extent the secre- 
tions of the intestinal canal, but excites catharsis by stimu- 
lating the muscular coat of the bowel. It is useful in acute 
inflammatory affection of the bowel and as a laxative in preg- 
nancy, anal fissure and painful hemorrhoids. 

What are the medicinal uses of potassium chlorate? 

It is an excellent local application in inflammatory condi- 



THERAPEUTICS AND MATERIA MEDIC A. 589 

tions of the mouth, and throat, being valuable in the various 
forms of stomatitis, in acute pharyngitis, in diphtheria and 
scarlet fever. 

How should poisoning by coal gas be treated? 

Antidotes, chlorine water as a spray, inhaled. Antago- 
nists, oxygen by inhalation 4 or 5 quarts. Ammonia vapor 
inhaled. Galvanism, by interrupted current to extremities. 
Artificial respiration, to be maintained steadily for hours. 
Rhythmic traction of the tongue. Fresh air in plenty; open 
all doors and windows. Coffee, black, a pint as enema. 
Venesection may be of service. Douche, alternately cold and 
warm, to head and chest. Horizontal position, clothing re- 
moved. Alcohol moderately by mouth or rectum. Catheter 
may be required in prolonged cases. Subsequently a warm 
bed, heat applied to the body and limbs, open windows, perfect 
quiet, Condy's fluid about the room, stimulants sparingly, 
cold acid drinks freely. 

Write a prescription for a cough mixture containing 
muriate of ammonia and an opiate, giving adult dose. 

January 1, 1903. For Joseph Wilson. 

R . Amrnonii chloridi 5 V 

Tr. opii cainph. f 3 v 

Syr. pruni virg f * iv 

M. S. — f 3 i every four hours. 

Joseph Joxes. M. D. 

What are the therapeutic uses of podophyllin? 

It is an excellent laxative in constipation associated with 
hepatic congestion. It tends to produce griping, and is usu- 
ally given with small doses of belladonna or hyoscyamus. 

What is the dose of Fowler's solution and what precau= 
tions should be observed in its administration? 

The dose is 1 to 5 minims. Potter advises that full doses 
of the solution should be taken at first, and always immedi- 
ately after food; the dose should then be gradually reduced. 
Susceptible persons often tolerate it better if a few drops of 



590 THERAPEUTICS AND MATERIA MEDICA. 

laudanum are administered with each dose. Swelling beneath 
the eyes is an indication of the physiologic limit for the em- 
ployment of the drug. 

From what part of the colchicum plant is the active 
principle obtained? 

From the corm and seed. 

What injurious effect is liable to follow the prolonged 
internal use of the preparations of silver? 

Argyria. The first sign of this condition is a slate-colored 
line along the margin of the gum with some inflammatory 
swelling. Subsequently grayish patches appear on various 
parts of the skin and mucous membrane and gradually extend 
over the whole body. As a rule, argyria does not produce 
serious effects on the health of the subject. The pigmenta- 
tion is due to a deposit of silver in the connective tissues. In 
the skin it is found in the corium. The discoloration is per- 
manent. 

Name a vesicant derived from (a) the animal kingdom, 
(b) the vegetable kingdom, (c) the mineral kingdom. 

(a) Cantharides, (b) mustard, (c) iodine. 

Write a prescription for diarrhea containing an alkali 
and an astringent suitable for a child of ten years. 

January 1, 1903. Walter. 

R . Sodii bicarbonatis 3 ii 

Bismuthis subcarbonatis 3 ii 

Tragacanthse 3 i 

Spts. chloroformi f 3 i 

Aquae cinnamomi f ^iv 

M. S. — Teaspoonful every four hours. 

Joseph Jones, M. D. 

What is the vulgar name for veratrum viride? What is 
its active principle and the dose of the principle? 

American hellebore. It contains several active principles, 
of which the most important is veratrine. The dose of the 
tincture is 3 to 6 drops. 



THERAPEUTICS AND MATERIA ME DIG A. 591 

For what medicinal purposes is senna used? 

It is used as a laxative in habitual constipation, and in 
larger doses as a cathartic. 

Write a prescription for an ointment containing a rube= 
facient and at least one other constituent. 

January 1, 1903. For John Smith. 

R • Unguenti hydrargyri nitratis ■ % iv 

Sulphuris • 3 ii 

Creosoti gtt. x 

Adipis. f J; i 

Fr. unguentum f 3 i 

S. Rub in well. James Jones, M. D. 

What is the usual physiologic action of an astringent 
administered internally? 

Astringents are agents which produce contraction of muscle 
fiber and condensation of other tissues. They lessen secre- 
tions from mucous membranes. 

What are the medical uses of ammonia? 

Ammonia is employed in medicine when a quickly-acting 
heart and respiratory stimulant is required. It is also used 
as an antacid and a counter-irritant. 

What are the therapeutic uses of lime (calcium)? 

Lime in its unslaked form has a great affinity for water, 
and readily combines with sulphur, thereby decomposing and 
destroying organic matter. Upon the skin its action is irri- 
tant and superficially caustic, but more severe on the mucous 
membrane, and if inhaled or swallowed it may produce dan- 
gerous inflammation, followed by ulceration. In weak solu- 
tion it has a sedative and an astringent effect, both locally 
and internally, and acts as an absorbent and antacid. 

For what pathologic conditions may capsicum be used? 

It is an excellent stomachic tonic in atonic dyspepsia and 
in that of chronic alcoholism with tremor and insomnia. In 
acute dipsomania large doses are effective in producing sleep 



592 THERAPEUTICS AND MATERIA MEDIC A. 

and promoting appetite. Locally, capsicum plaster is a mild 
counter-irritant. 

What is the ordinary relative strength of a tincture to 
a fluid extract of the same drug? 

In strength the fluid extracts, a cubic centimeter in each 
case, represent the medicinal powers of 1 dram of the drug. 
Tinctures are very much weaker, 5 centimeters of the tincture 
representing various quantities in drams of the drug, from 
5 to 50. 

Name three agents which are used to promote menstru= 
ation. 

Potassium permanganate, purgatives, as castor oil, and 
ergot. 

How do the preparations of gentian affect the human 
system and in what conditions are they indicated? 

Gentian is used exclusively as a bitter tonic. In atonic 
dyspepsia it increases the appetite and stimulates digestion. 

The dose of a medicine given by the mouth being i grain, 
what would be the equivalent dose for hypodermic use and 
what for administration by the rectum? 

For hypodermic injection the dose should be % or % of 
that used by the mouth. By the rectum f of the same. 

How should a case of poisoning with chloral hydrate be 
treated? 

The patient should be aroused by friction, douches, etc., 
but must not be made to walk, as in opium poisoning, on ac- 
count of heart failure. Cardiac and respiratory stimulants 
should be given freely, as ammonia, atropine and strychnine. 
Artificial respiration should be resorted to early, before the 
development of asphyxia. 

In what conditions may cathartics be useful in the treat= 
ment of diarrhea or dysentery? 

Cathartics are useful in the treatment of diarrhea and dys- 



THERAPEUTICS AND MATERIA MEDIC A. 593 

enteiy, especially early in the course of this condition, in the 
case of diarrhea for the purpose of removing offending mate- 
rial, as indigestible food, discharges, bacteria, etc. 

Define a laxative, a saline purgative, a drastic purgative, 
a hydragogue purgative and a cholagogue purgative, with 
an example of each. 

Laxatives are drugs which excite moderate peristalsis and 
produce soft stools without irritation, as sulphur. Saline 
purgatives include the neutral salts of metals, of the alkalies 
or alkaline earths; they stimulate the intestinal glands to 
increased secretions and produce a copious evacuation, as 
Epsom salts. A drastic purgative produces violent peri- 
stalsis and watery stools, with much griping pain and tenes- 
mus; in large doses irritant poisoning results, as jalap. Hy- 
dragogue purgatives are those which remove a large quantity 
of water from the vessels, as elaterium. Cholagogue purga- 
tives stimulate the discharge of bile and produce free purga- 
tion, as podophyllin. 

Would you administer charcoal internally, and if so in 
what dose and for what purpose? 

It may be given with advantage in chronic gastric catarrh, 
cancer, intestinal dyspepsia and diarrhea when flatulence is a 
prominent symptom. Dose is 10 to 20 grains. 

What are the physiologic effects of gelsemium? 

Medicinal doses do not affect the circulation. Toxic doses 
depress the heart. It is a marked depressant to the spinal 
cord, and in toxic doses produces paralysis. The drug kills 
by paralyzing the respiratory center. Locally the drug 
causes dilatation of the pupil, probably from paralysis of the 
oculo-motor nerve. 

Describe the therapeutic uses of jalap and state how it 
differs in effect from aloes. 

In moderate dose jalap acts as a hydragogue cathartic, pro- 
ducing copious watery discharges. It is best given in the 
form of compound jalap powder in conditions of general 

38 



594 THERAPEUTICS AND MATERIA MEDIC A. 

dropsy, and should never be employed in simple constipation. 
Aloes is a eholagogue cathartic, stimulating the discharge of 
bile. 

Name two remedies which are commonly used to pro= 
mote intestinal peristalsis. 

Belladonna and nux vomica. 

What are the therapeutic uses of guaiac? 

Used locally and internally in acute bronchitis; often pre- 
scribed in chronic rheumatism, gout, sciatica and lumbago. 

Name the official bromides. 

The bromides of potassium, sodium, lithium, ammonium, 
strontium and zinc. 

Describe the therapeutic uses of ox=ga!l. 

It is a tonic, antiseptic and purgative, stimulating the ab- 
sorption powers of the mucous membrane. It is frequently 
used as a laxative in constipation. 

Where does buckthorn grow? Give the official prepara= 
tion and dose. 

In Europe. Fluid extract of frangula. Dose y 2 to 2 
drachms. 

What are the therapeutic uses of gelsemium? 

It is indicated in all conditions of exalted nerve function, 
and contra-indicated whenever the heart is weak. It is espe- 
cially useful in cerebro-spinal meningitis, mania, persistent 
insomnia, neuralgia, dysmenorrhea, incontinence of urine, 
irritation of the bladder, spasmodic coughs and remittent or 
typho-malarial fevers. 

What is the purgative dose of acetate of potassium? 

Two to four drachms. 

What is the common name and therapeutic use of 
plumbi acetatis? 

Sugar of lead. It is a component of the mixture of lead 



THERAPEUTICS AND MATERIA MEDICA. 595 

water and laudanum, which, is employed in bruises and in- 
flammatory swellings where the skin is not broken. It is 
used in solution as a lotion in skin diseases and pruritus, and 
is employed as an astringent in diarrhea. 

How do official waters, e. g. aqua camphorae, differ 
from solutions, e. g. liquor calcis? 

Waters are aqueous solutions of volatile substances ; liquors 
are all aqueous solutions of non-volatile substances. 

How do potassium acetate and potassium bitartrate 
compare as diuretics and purgatives? 

The acetate is the most certain diuretic; the bitartrate is 
the most active cathartic. 

Give the common name and the official preparations of 
prunus Virginiana. 

Wild cherry. The official preparations are the fluid ex- 
tract, infusion and syrup. 

On what chemical change in the intestinal tract does 
the purgative action of castor oil depend? 

The oil is decomposed by the pancreatic juice setting free 
ricinoteric acid, which produces purgation by a mildly irritant 
action on the bowels, stimulating the glands and muscular 
coat, but not the liver. 

What are the therapeutic uses of acetic acid? 

Used internally as a mild refrigerant and antiscorbutic, 
and as an antidote in poisoning by alkalies, such as ammonia. 
Locally it is used to check hemorrhages and as an escharotic. 

What is the proportion of mercury in blue pill? What 
is the dose of blue pill? 

It contains 33 per cent, of mercury. Dose 1 to 20 grains. 

What effect has benzoin on the urine? Name the prep= 
arations of benzoin. 

It renders the urine acid and increases its quantity. The 
preparations of benzoin are adeps benzoin, tinctura benzoini, 



596 THERAPEUTICS AND MATERIA MEDIC A. 

tinct. benzoini composita, acidum benzoicum, ammonii ben- 
zoas, lithii benzoas, iodi benzoas. 

What are the alkaloids of pilocarpus and how do they 
compare in physiologic effect? 

The alkalies of pilocarpus are pilocarpine, jaborine, antag- 
onistic to pilocarpine in action; pilocarpidine, analogous to 
pilocarpine, and jaboridine, which is analogous to jaborine. 

What is the source of camphor and what is the dose of 
spiritus camphorae? 

Camphor is a stearopten obtained from the Connamonium 
camphorae, a tree of the natural order Laurinece (indigenous 
to China and Japan), purified by sublimation. Dose of the 
spirit 5 to 20 minims. 

Give the common name and the therapeutic uses of 
potassium bitartrate. 

Cream of tartar. It is an agreeable laxative, and also is 
used as a diuretic in infusion of juniper in general cardiac 
dropsy. 

Give the source and preparations of gum arabic. 

Acacia, gum arabic, is a gummy exudation of Acacia Sen- 
egal, a small tree native to Africa. Its preparations are the 
syrups and mucilage. It enters also into the composition of 
official troches, etc. 

Mention the therapeutic uses of nitric acid. 

It is locally a powerful eschar otic, and internally in dilute 
form in bilious affections. It lessens phosphatic deposits and 
acts as an astringent to the system, diminishing the profuse 
expectoration in bronchorrhea and phthisis. 

Give the physiologic action and the therapeutic uses of 
sarsaparilla. 

It is doubtful if it possesses any physiologic action. Some, 
however, claim it to be diuretic, diaphoretic, tonic and alter- 
ative. Its chief value is as an excipient for administering 
potassium iodide and mercuric chloride in syphilis. 



THERAPEUTICS AND MATERIA MEDIC A. 597 

Name three drugs which are administered internally to 
arrest bleeding. 

Ergot, gallic acid and hematoxylon. 

What are the therapeutic uses of magnesia? 

Magnesia is the oxide of magnesium. It is used as an ant- 
acid and laxative in acidity, sick headache, colic, etc., and as 
an antidote in poisoning by acids, arsenic, phosphorus and 
the mercuric and copper salts. 

Mention the medical uses of the oil of turpentine. 

The oil of turpentine is employed externally as a rubefa- 
cient and counter-irritant in many conditions causing pain 
and inflammation. The liniment is in constant use for sprain, 
neuralgia and other slight local affections. Internally it is 
best employed in ulceration and hemorrhage of the intestines, 
and in passive hemorrhage from other organs. It is also used 
as an anthelmintic against tape-worm, and is of value in flatu- 
lent colic. It is employed in chronic bronchitis and chronic 
inflammations of the mucous membranes generally. 

For what are the preparations of juniper used in medi- 
cines? 

Juniper is a stomachic tonic, diaphoretic, diuretic and 
aphrodisiac. The oil acts therapeutically like the oil of tur- 
pentine, and may be used in chronic cystitis, etc., but is 
contra-indicated where acute inflammations of the kidney 
exist. 

How should a case of poisoning with atropine be treated? 

Tannic acid should be given freely and the stomach emptied 
by an emetic or the stomach-pump. Collapse must be met by 
the use of heart stimulants, such as ammonia, alcohol and 
nitroglycerin. 

What is the vulgar name of physostigma? 

Calabar bean. 



598 THERAPEUTICS AND MATERIA MEDIC A. 

What are the therapeutic uses of the preparations of 
zinc? 

The acetate is used as an astringent application in conjunc- 
tivitis and subacute gonorrhea. The precipitated zinc car- 
bonate is used as a sedative astringent in acute inflammatory 
affections of the skin, such as erythema and eczema. The 
chloride is used as an astringent antiseptic and caustic. It 
is also used in chronic inflammation of the mucous mem- 
branes. The oxide is employed in the form of an ointment 
or powder externally as a mild astringent and sedative in 
burns, acute ulcers, etc. Internally it is of doubtful value 
as an anti-spasmodic and anti-hydrotic. The phosphide of 
zinc is employed in the same class of cases in which phos- 
phorus is indicated. The sulphate of zinc is employed locally 
as an astringent, and internally is used in chronic dysentery 
and diarrhea, as well as an emetic in large doses in cases of 
narcotic poison. 

Name three official preparations of camphor. 

Aqua camphorcu, linimentum camphorce and spiritus cam- 
phorce. 

Write a prescription containing some preparation of iron 
in a delectable form. 

January 1, ]903. Foe, Wm. Jones. 

& • Tincturse ferri chloridi f 3 ii 

Acidi phosphorici diluti fj^ iii 

Spiritus limonis f 3; i 

Syrupi f% iiss 

Aquam ad f 5 vi 

M. S. — Tablespoonful after meals. 

John Smith, M. D. 

What preparations of copper are used in medicine and 
for what purposes? 

The only official salt of copper is the sulphate; it is useful 
in phosphorus poisoning both as an emetic and a chemical 
antidote. The application of the solid crystal is often useful 
for its astringent and stimulating qualities. It is also useful 



THERAPEUTICS AND MATERIA MEDIC A. 599 

in gonorrhea in the subacute stage. Internally it is some- 
times employed in chronic diarrhea. 

What are the therapeutic uses and the preparations of 
borax? 

Borax is sodium borate, which is a powerful antiseptic and 
disinfectant. It has been used internally in amenorrhea, 
dysmenorrhea and puerperal convulsions and epilepsy. In 
the form of a wash it is of value as an anti-pruritic. Boric 
acid is prepared largely from borax by the action of sulphuric 
acid. It is an efficient antiseptic, disinfectant and deodorant. 

With what remedies should spasmodic croup be treated? 
Name three suitable ones. 

With emetics, as ipecac, and with anti-spasmodics, such as 
the bromides. Lobelia is a useful remedy. 

Describe the medicinal uses of hydrocyanic acid. 

Hydrocyanic acid is used solely to allay irritation of the 
peripheral nerves. Thus it is employed internally for the 
cough of phthisis and chronic bronchitis, for gastralgia in 
obstinate vomiting, and externally to subdue the itching in 
pruritis, eczema and urticaria. 

Mention the conditions which affect the dosage of medi= 
cines. 

The age of the patient, the personal idiosyncrasy, the con- 
dition of the heart, kidneys, nervous and respiratory system. 

What class of acids would you use to acidify alkaline 
urine? 

Benzoic acid and its derivatives, as benzoate of sodium and 
ammonium. 

What is the dose of phenacetin as an antipyretic? 

Dose 8 to 10 grains every 4 to 6 hours. 

What is the composition of the so=cal!ed green soap? 

Green soap is prepared from potassa and linseed oil. 



600 THERAPEUTICS AND MATERIA MEDIC A. 

Where does arnica grow most abundantly? What part 
of the plant is used in medicine? 

In the mountains of northern Enrope and Siberia. Both 
the flowers and the roots are official. 

What is glycerine and what are its therapeutic uses? 

Glycerin is obtained by the decomposition of vegetable or 
animal fats or fixed oils. It is a trihydric alcohol, existing 
in fats and fixed oils in combination with the fatty acids. 
Externally it is used in various forms as an emollient. In 
the various acute inflammations of the fauces, it makes an 
excellent vehicle for carrying other drugs. Being hygro- 
scopic, it not only depletes the turgid vessels, but it spreads 
the medicant over the entire surface. It is especially useful 
in tampons in such conditions as uterine congestion. It may 
be employed in suppository in obstinate constipation. It is 
sometimes used as a substitute for sugar in diabetes. 

How many grains of the hydrochlorate of cocaine are 
contained in one ounce of a ten per cent, solution? 

Forty-eight grains. 

What is the dose of the fluid extract of senna? 

Two to four drams. 

What injury may result from large doses or long con= 
tinued use of potassium chlorate? 

The chlorate is distinctly irritant to the kidneys. An in- 
flammation of these organs may follow its use. 

Give the habitat of squills and state which of its prep= 
arations are used in medicine. 

It is native to southern Europe. The preparations are 
vinegar of squills, fluid extract, syrup, compound syrup and 
tincture. 

Describe the therapeutic uses of olive oil and state where 
it is principally produced. 

It is produced principally in southern Europe, California 



THERAPEUTICS AND MATERIA MEDIC A. 601 

and Australia. Externally used it is a good protective from 
the air, and if rubbed into the skin is absorbed by the lym- 
phatics and is directly nutritive. Internally it is a food and 
a mild laxative, and in quantity protects the mucous mem- 
branes against the action of poisonous substances. 

How should phosphorus poisoning be treated? 

Immediate full dose of sulphate of copper, which is an 
emetic as well as a chemical antidote. Potassium perman- 
ganate and French oil of turpentine are also of value. 

What is the dose of oleum erigerontis? 

The oil of neabane is not official. It has the same action as 
oil of turpentine in a milder way. Dose 10 to 30 minims. 

Write the following prescription in the metric system: 

R . Ammonii bromidi 2 drams 

Sp. ammonise aromat 1 dram 

Aquse 4 ounces 

Misce. 

Be . Ammonii bromidi grams 7. 78 

Sp. ammonise aromat grams 3. 89 

Aquse cubic c. c. 118. 

Misce. 
What is the dose of oleum sabinae? 

One to five drops. 

What medicine would you give to promote bone growth? 

Some of the preparations of lime, as lime water, or the 
carbonate or phosphate. 

What is the alkaloid of pomegranate and for what is it 
used? 

Pellatierine; it is a teniafuge. 

By what other names is saltpetre known? 

Potassium nitrate and nitre. 

In what dose may sulphonal be administered to an adult 
to produce a soporific effect? 

It may be given in 10 to 20 grain doses in hot milk about 2 
hours before retiring. 



602 THERAPEUTICS AND MATERIA MEDICA. 

To what chemical change does sulphur ointment owe its 
efficiency as a parasiticide? 

Sulphur ointment contains an alkaline ingredient and de- 
velops sulphides which are powerful anti-parasitics. 

What are the uses of lactic acid in medical practice and 
what pathologic conditions may its administration pro= 
duce? 

It is employed as a mild caustic, a digestant and intestinal 
antiseptic. It is a valuable local remedy in laryngeal tuber- 
culosis, and internally in cholera, typhoid fever, simple diar- 
rhea and the diarrhea of infants. It is supposed to cause 
acute rheumatism when in excess and free in the blood. 

Write the following prescription in the metric system: 

1$ . Morphinse sulphatis grains 6 

Sodii boratis drams 4 

Aquse camphorse fl. ounces 6 

R . Morphinse sulphatis 387 milligrams 

Sodii boratis 15.5 grams 

Aquse camphorse. 177. cubic c. c. 

What is the effect of full doses of opium on respiration 
and to what extent may this effect be safely carried in 
treatment? 

In full dose there is irregular and slow respiration. It 
should not be used when there is profuse expectoration, as 
the lowering of excitability of the respiratory center which it 
produces would be dangerous in such a case. Morphine is 
combined with atropine to overcome the effect of the former 
on the circulation. It should be avoided in all organic dis- 
eases of the lungs associated with weak respiration. 

Where is colocynth obtained and for what is it used? 

Colocynth is the fruit of citrullus colocynthis deprived 
of its rind. The plant is a native of Spain and Asiatic 
Turkey. It is classed among the tonic, astringent and resin- 
bearing purgatives. In moderate doses it increases peristal- 



THERAPEUTICS AND MATERIA MEDIC A. 603 

sis and the intestinal glandular secretion ; watery evacuations 
with griping pain. 

What is the comparative action of strychnine and alco= 
hoi on the arterioles? 

Strychnine raises the arterial pressure by stimulating the 
vasomotor center in the medulla. Alcohol inhibits the vaso- 
motor system, causing dilatation of all the vessels of the body, 
especially those of the periphery. The blood pressure is 
raised, however, owing to the great increase of cardiac action, 
which overcomes the results of the arteriole dilatation. 

How may carbolic acid poisoning be produced and how 
treated? 

Carbolic acid poisoning may be induced by the local use, 
especially of weak solutions, of the acid, as well as by the 
internal ingestion of carbolic acid or its derivatives. The 
treatment of the poisoning consists of the administration of 
the antidote, which is a soluble sulphate, as sulphate of mag- 
nesium ; this unites with the acid, forming an insoluble sulpho- 
carbolate. Evacuation of the stomach, the application of 
external heat and stimulants and the use of mucilaginous 
drinks are indicated. 

Would you write for potassium chlorate and tannin in 
the same prescription? Give reason for your answer. 

No. Tannin precipitates potassium chlorate. 

Mention the therapeutic uses of gamboge. 

Gamboge is an irritant purgative, decidedly diaphoretic; 
its catharsis is accompanied by vomiting and colic. It has 
no cholagogue action. Its use, for the most part, is limited 
to the compound cathartic pill, of which it is a constituent. 

Where is kousso obtained? What preparation is used 
and for what purpose? 

Kousso is a native of Abyssinia ; it is used in the form of the 
fluid extract as an anthelmintic against tape-worm. 



604 THERAPEUTICS AND MATERIA MEDIC A. 

What remedies should be used for hemorrhages from 
mucous surfaces? 

The astringents and vaso-contractors ; the extract of supra- 
renal gland is probably of greatest value; ergot, gallic acid 
and opium are employed internally. 

On what theory can the use of salol in diarrheal diseases 
be advocated? 

In the intestine it is separated into carbolic and salicylic 
acids and acts as an antiseptic. It is free from irritating 
properties. 

For what is copaiba used in medical practice? 

Copaiba is used in subacute or chronic inflammations of the 
genito-urinary tract. 

Name a drug commonly used which affects the color of 
the stools without altering the constituency, and explain 
the cause. 

The organic salts of iron blacken the feces by conversion 
into a sulphide. 

Describe the three stages of chloroform narcosis. 

1st stage : This stage is very short and the symptoms are 
very similar to those of alcoholic intoxication. Consciousness 
is not lost but the sensibility is generally dulled, but rarely 
altogether abolished. 

2d stage : This is the stage of anesthesia, consciousness and 
sensibility are abolished, the muscles are relaxed and the pa- 
tient is quiet. The pulse is generally normal in frequency, 
but somewhat weakened. 

3d stage : This stage is one of profound narcosis with ster- 
torous breathing, intense muscular relaxation, abolition of the 
ordinary reflexes and fall of bodily temperature. Pulse is 
weak and rapid. 

Describe the three stages of anesthesia under ether. 

1st stage: Burning in the fauces, feeling of strangulation, 
sense of exhilaration, lightness in the head with a buzzing or 



THERAPEUTICS AND MATERIA MEDIC A. 605 

roaring in the ears. These symptoms are soon followed by a 
feeling that the surroundings of the patient are at a distance, 
which fades into semi-unconsciousness with visions and illu- 
sions. Patients may laugh, shout, weep, fight or pray. 

2d stage: This stage begins with a complete loss of con- 
sciousness. Muscular rigidity soon passes off and the patient 
is quiet. Eespiration is slow and regular. 

3d stage : Same as the third stage under chloroform narcosis. 

Give the contraindications to the use of anesthetics. 

Organic brain disease, including tumors, atheromatous con- 
ditions of the blood vessels, organic affections of the heart, 
lungs and kidneys (Wood). Some authorities add diabetes 
mellitus, chronic alcoholism and enlarged tonsils. 

Why is the use of ether as an anesthetic contra=indicated 
in diseases of the lungs and kidneys? 

Because it is eliminated by the lungs and kidneys, and on 
account of its irritating qualities it would aggravate the 
diseased condition. 

What is meant by cataphoric application of a remedy? 

By cataphoric application of a remedy is meant the in- 
filtrating of the tissue with some drug by electrical osmosis. 

Give the indications for the use in producing sleep of 

(a) morphine, (b) chloral, (c) potassium bromide. 

(a) Morphine is used when sleeplessness is due to pain. 

(b) Chloral is indicated when sleeplessness is due to mental 
overwork and where a more powerful hypnotic than potassium 
bromide is required. If the heart or stomach are in bad con- 
dition it should not be given, (c) Potassium bromide is given 
when insomnia is caused by cerebral excitement, nervous ex- 
citement (especially when connected with the genital function) 
and motor activity. According to Wood it is contra-indicated 
by an excessive irritability of the gastro-intestinal mucous 
membrane and great exhaustion. 



606 THERAPEUTICS AND MATERIA MEDICA. 

(a) What systemic conditions contra=indicate the use of 
nitrous oxide gas? (b) State why. 

(a) Atheromatous vessels, fatty heart and pulmonary em- 
physema. (Burchard). (b) Nitrous oxide gas increases blood 
pressure and in atheromatous degeneration of the arteries this 
may result in rupture of these vessels and if in the brain, 
apoplexy or early death may ensue. 

In fatty heart the muscles are weakened, and on account of 
the increased resistance in the blood-vessels there may be 
sudden dilatation of this organ. 

In pulmonary emphysema the danger is in the engorgement 
of the blood vessels of the lungs which causes an increased re- 
sistance to the right heart, which may result in the sudden 
dilatation of this organ, or there may be pulmonary edema 
or hemorrhage. 

(a) What are topical remedies? (b) Mention two 
classes, (c) Give two examples of each. 

(a) Topical remedies are those which are applied locally. 
(b) Plasters and liniments, (c) Belladonna plaster and cap- 
sicum plaster — turpentine liniment and chloroform liniment. 

Give the signs of danger in chloroform anesthesia and 
tell what should be done. 

Lividity of the face, irregular or stertorous breathing 
or feebleness of the pulse. Withdraw the anesthetic, lower 
the head, use artificial respiration and give a hypodermic 
injection of strychnine, digitalis, or ammonia. 

When is chloroform preferred to ether as an anesthetic? 

In acute inflammation of the bronchi or lungs, aneurism, 
atheroma and nephritis. 

Name the accidents that may happen during the admin= 
istration of ether, and give the treatment in each case. 

In the early part of the administration of ether we may 
have failure of respiration, which is due to reflex spasm of 
the laryngeal muscles excited by the ether. By giving more 
air with the ether we can correct this trouble. 



THERAPEUTICS AND MATERIA MEDICA. 607 

Embarrassed respiration may be due to the accumulation 
of mucus in the upper air passages. In this condition we sim- 
ply turn the head to one side. 

Respiratory failure may be caused by the action of the 
either on the respiratory centre. In this case we withdraw 
the ether; push the jaw forward by pressing on its angles, 
draw the tongue forward by means of a tenaculum or for- 
ceps and make rhythmic traction of the tongue. Pour ether 
on the abdomen or chest in order to stimulate inspiration by 
reflex action, give strychnine and atropin hypodermically. 
Practice artificial respiration. 

Name the most common aftereffects of the administra= 
tion of ether. 

Nausea and vomiting. 

Under what conditions is ether contra=indicated as an 
anesthetic? 

In acute inflammatory infections of the respiratory tract, 
advanced arteriosclerosis, severe nephritis, especially when 
associated with cardiovascular lesions and anemia when the 
hemoglobin is less than 30%. Diabetes mellitus, especially 
when well established and associated with acetonuria 
(Stevens). 



PRACTICE OF MEDICINE. 



What is dysphagia, and with what pathological condition 
is it associated? 

Dysphagia is difficulty or pain in swallowing. It may be 
clue to causes in the mouth and fauces, such as glossitis, cancer 
of the tongue, to various forms of stomatitis, tonsillitis and 
pharyngitis. Some of the exanthemata, such as scarlet fever 
and variola, give rise to lesions of the throat, diphtheria, 
spasm or paralysis of the pharynx, disease of the larynx, dis- 
ease of the esophagus, such as stricture, cancer, etc. Finally, 
from pressure from the outside, such as from an enlarged 
thyroid gland, thoracic aneurysm, mediastinal tumor, etc., 
and from pleural and pericardial effusion. 

How would aneurysm of the abdominal aorta affect the 
dorsalis pedis artery pulse as compared with the radial 
pulse? 

The pulse of the dorsalis pedis artery compared with the 
radial pulse would be small and delayed. 

What conditions predispose to cerebral hemorrhage? 

Heredity is important; many individuals inherit the apo- 
plectic constitution. It is a disease of middle life, and more 
common in the male sex. Diseases of the blood vessels are 
important factors. It may follow the infectious fevers and 
diseases producing disturbances of the blood. Embolism is 
an important factor. Hypertrophy of the heart, exertion or 
excitement frequently cause rupture of the diseased blood 
vessels. 

39 (609) 



610 PRACTICE OF MEDICINE. 

What are the causes of endocarditis? 

The greatest number of cases are the result of rheumatic 
fever. Chorea is also a cause. The acute exanthemata also 
give rise to it, also pneumonia, erysipelas, sepsis, puer- 
peral diseases, and sometimes gonorrhea. Tuberculosis, gout, 
renal disease and diabetes are etiological factors. Trauma 
has also been given as a cause. It occurs in fetal life. It 
may sometimes be secondary, from extension of the disease 
from the myocardium or aorta. 

Differentiate between cerebral vomiting and gastric 
vomiting. 

Cerebral vomiting occurs without nausea, often with a clean 
tongue, and is not related to the taking of food. In gastric 
vomiting there is the history of some gastro-intestinal affec- 
tion. The tongue is coated, and there is always considerable 
nausea and much retching. 

Give the characteristic differences between diabetes 
insipidus and diabetes mellitus. 

In diabetes insipidus the urine is of low specific gravity, 
never over 1010 ; there is no sugar present, no itching of the 
skin and genitalia, no hunger, no tendency to the formation 
of carbuncles or boils. In diabetes mellitus the urine is of 
high specific gravity, 1030 and over, sugar is present in the 
urine, there is itching of the skin, great hunger, tendency to 
formation of boils, loss of weight, and frequently an etherial 
odcr of the breath. 

Give the cause of vertigo. 

Vertigo occurs in the course of neurasthenia and lithemia, 
from gastric disorders, from arteriosclerosis, valvular disease 
of the heart and aneurysm, from Meniere's disease, from 
reflex causes, such as disease of the eye, nose and larynx. It 
also occurs in many nervous diseases, such as epilepsy, etc. 

Describe pyuria and state its import. 

Pyuria is pus in the urine, and is an important symptom 



PRACTICE OF MEDICINE. 611 

in many diseases of the urinary tract, from the kidney to the 
end of the urethra. It is present in urethritis, cystitis, ure- 
teritis, pyelitis and pyelonephritis. Pus may be caused by 
rupture of an abscess in the urinary tract (especially the 
bladder) ; this may occur in salpingitis, abscess of the ovary, 
extra-uterine pregnancy, cysts of various kinds, psoas and 
other forms of abscess, etc. 

Describe leukemia and mention the pathological changes 
occurring in this disease. 

Leukemia is a disease in which the white blood corpuscles 
are greatly increased in number ; the percentage of the various 
forms also differ greatly from the normal. It is character- 
ized anatomically by changes in the spleen, lymphatic glands 
or bone marrow, singly or combined. In the splenomedullary 
form the spleen is greatly enlarged, and it may weigh ten 
pounds or more. The capsule is thickened, and the surface 
of the organ somewhat irregular. On section it is quite firm. 
The color of the pulp is reddish-brown. Infarcts are common. 
The gross appearance of the blood is altered, occasionally 
being milky in character, the specific gravity is decreased, the 
alkalinity is someAvhat diminished, and coagulation is slightly 
retarded. The leukocytes show a great increase in number, 
from 250,000-500,000 or more per cmm. In the lymphatic 
variety groups of lymph glands are enlarged, owing to hyper- 
plasia of the lymphoid cells, and the spleen is slightly increased 
in size. The gross appearance of the blood may show very 
slight change or resemble the variety just described. The leu- 
kocytes are also greatly increased in number, but not to the 
extent that they are in the splenomedullary form. Exami- 
nation of the stained films shows an enormous increase in the 
lymphocytes. 

Give the symptoms indicative of impacted gallstone. 

When the gallstone has become impacted there is an arrest 
of the pain. Jaundice is marked, the urine shows bile pig- 
ments, and the stools are clay-colored. There is hepatic inter- 



612 PRACTICE OF MEDICINE. 

mittent fever, sometimes called Charcot's fever. This con- 
sists of high temperature, chills and sweating. While this 
fever is paroxysmal, it does not show the regularity of a 
malarial attack. 

Give the treatment of yellow fever. 

Disinfection of the person and all effects. Strict quaran- 
tine. A mild cathartic may be given at the onset with advan- 
tage. Vomiting and gastric irritability may be treated by 
the administration of carbolic acid, cocaine or broken doses 
of calomel. The fever should be treated by cold applications 
to the head and cold sponging. For the pain opium in some 
form is useful. Strychnine is valuable as a cardiac tonic. 
For the hemorrhage, opium, ergot and suprarenal extract 
may be administered. 

Outline appropriate treatment for Asiatic cholera. 

Complete isolation of the sick and thorough disinfection of 
all discharges and all articles of clothing are absolutely 
necessary. Efficient quarantine must be established. All 
milk and water should be boiled, and no raw fruit or vege- 
table should be eaten. In the stage of premonitory diarrhea 
it is considered good practice to administer a prompt laxative. 
If there be great pain opium may be given hypodermically. 
Salol and guaiacol carbonate may be given from time to time 
as intestinal antiseptics. In the stage of serous diarrhea the 
patient should be wrapped in flannels and external heat ap- 
plied to the body. If there be cramp, friction of the muscles 
is useful. Fluids should only be allowed in very small quan- 
tities. Enteroclysis should be used in this stage. When col- 
lapse sets in, hypodermoclysis of a normal salt solution should 
be given. Strychnine may be given by the skin, but it must 
be remembered (that as absorption is slow, accumulation may 
occur. 

What are the causes and treatment of palpitation of the 
heart? 

This may be due to reflex causes, such as disease of the 



PRACTICE OF MEDICINE. 613 

stomach, disease of the genito-urinary apparatus, and sexual 
excesses. Toxic causes may give rise to it, such as the abuse 
of alcohol, tobacco, tea and coffee. Gout and anemia are 
productive features, and the condition occurs in inanition and 
marasmus. Finally, it is due to disease of the heart itself, 
such as organic disease, and it is an important symptom of 
exophthalmic goitre. The treatment consists in removing the 
cause, if possible, and is then symptomatic. Rest in the re- 
cumbent posture and an icebag over the heart are useful. 

What are the causes and symptoms of dilatation of the 
stomach? 

The dilatation may be acute or chronic. It may be due to 
obstruction of the pyloric end of the stomach, such as con- 
genital stenosis, the cicatrices resulting from gastric ulcer, 
and from tumors, the most common being malignant. Motor 
insufficiency of the stomach may give rise to dilatation; this 
may result from overeating or drinking, and frequently occurs 
in beer drinkers. The symptoms are general feebleness, ane- 
mia, emaciation, thirst, scanty urine, sallow and hollowed face, 
flabby coated tongue, pyrosis, chilliness, cyanosis, subnormal 
temperature and nervous symptoms. Pain and vomiting are 
always present. The outline of the stomach may be demon- 
strated by means of the X-ray. 

What is scurvy, how should it be prevented and treated? 

Scurvy is an affection characterized by anemia, by swollen, 
tender and bleeding gums, by manifestations of purpura and 
by great prostration due to improper food. The prevention 
of the condition is due to the use of anti-scorbutic food on 
shipboard or among the army supplies. In the treatment, 
antiseptic mouth washes are of use. Fresh vegetables should 
be administered. Lemon-juice is very valuable, as are also 
bitter tonics. 

Give in detail the treatment of diphtheria. 

The prophylaxis is highly important, the disease being very 
contagious and easily transmitted. The patient should be 



614 PRACTICE OF MEDICINE. 

strictly isolated. Efficient disinfection is also necessary. 
The food must be nutritious and easily digested. If the 
patient cannot swallow, rectal alimentation must be resorted 
to. Alcohol is necessary, and must be given freely, even in 
mild cases. The membrane must not be removed. Antiseptic 
and soothing applications are employed ; inhalations of quick- 
lime and steam in all cases in which there is danger of invasion 
of the larynx are useful. Hydrogen dioxide in solution is 
serviceable as a mouth wash. Internally, the tincture of 
chloride of iron may be given in medium doses. Calomel or 
corrosive sublimate in appropriate doses are useful. The 
antitoxin treatment, however, is the most important. The 
dose in individual cases varies; from 3,000 antitoxin units 
may be given at a dose, but this may be increased in severe 
cases and repeated. In laryngeal cases intubation and tra- 
cheotomy may have to be resorted to. 

What is the prognosis of suppurative nephritis secondary 
to cystitis? Outline the treatment of the condition. 

The prognosis is unfavorable, and the treatment is surgical. 

Give the etiology of tubercular peritonitis and the treat= 
ment. 

The disease appears at all ages, but it is more common in 
childhood. Males are more frequently attacked than females, 
and it is more often met with in the negro than in the white 
race. It is also found associated with intestinal or mesenteric 
tuberculosis. The condition may be primary in the perito- 
neum, and may be confined solely to this membrane. A com- 
mon mode of infection is through the intestines ; this may also 
occur through the lymphatics or by extension from the pleura 
or the pericardium. It is often of the miliary variety, but 
also of the chronic ulcerative and chronic fibroid forms. The 
modern treatment of this condition is surgical, the best results 
having been obtained by opening the abdomen and producing 
adhesions. 



PRACTICE OF MEDICINE. 615 

Give the prophylactic treatment of gout. 

As nearly as possible a vegetable diet should be adhered to, 
as animal food gives rise to uric acid. Water should be par- 
taken of plentifully. Alcoholic and malt liquors, especially 
the rich, sweet wines, such as port, sherry, champagne, should 
be particularly prohibited. Systematic bathing, regular ex- 
ercise in the open air, avoidance, of exposure to cold and damp- 
ness are important. 

At what age is spasmodic croup most common? Give 
the symptoms and treatment of spasmodic croup. 

The disease is most common in children before the age of 
puberty. The attack begins suddenly, most often at night. 
The first indication is usually a hoarse metallic cough, fol- 
lowed by dyspnea. In severe cases the dyspnea is so extreme 
that cyanosis of the face and extremities occurs. There is 
some elevation of temperature. The cough is unproductive 
at first, but at the close of the attack free expectoration may 
occur. The child should at once be immersed in a warm bath, 
and an emetic promptly given. Inhalations of steam are also 
useful. Between the attacks the child should have tonic 
treatment. 

Give the etiology, duration and prognosis of pertussis. 

It is an infectious disease of early childhood, and common 
between the second and seventh year. The disease usually 
lasts from four to six weeks. The prognosis, as a rule, is 
favorable, the danger being due to complications. 

Describe the treatment of biliary lithiasis. 

The prophylaxis consists in appropriate diet, exercise and 
general favorable hygiene. In women tight lacing should be 
avoided. Warm baths, regular exercise in the fresh air, etc., 
should be recommended. The patient should avoid indul- 
gence in sweet and starchy foods. Constipation should be 
corrected. Massage has been strongly advised. For the 
treatment of the attack hot fomentations should be applied 
over the liver. For the pain hypodermic injections of mor- 



616 PRACTICE OF MEDICINE. 

phine give relief. If the condition is not relieved by medical 
means, if the jaundice persist, and especially if symptoms of 
Charcot's fever appear, surgical interference should be re- 
sorted to. 

Give the etiology and treatment of St. Vitus' dance. 

Chorea is a disease of childhood, although it may occur at 
any age. Females are most often attacked, and the disease is 
more common in the temperate climate. It is most prevalent 
in the spring months. Acute rheumatic fever has been noted 
as an exciting cause in a large number of cases. Fright, 
shock and worry are predisposing causes. It may be due to 
reflex causes, such as intestinal worms, eye-strain, nasal dis- 
ease and sexual disorders. The treatment consists in long 
hours of rest, especially in bed. If the child be attending 
school it had better discontinue and remain at home. The 
diet should be simple, meats and highly-seasoned foods should 
be excluded. Arsenic, antipyrine, bromide of zinc and qui- 
nine are the most useful drugs. 

Give the etiology, symptoms and treatment of cirrhosis 
of the liver. 

The disease occurs most often in the male sex, and is very 
frequently due to alcohol. In the newborn the affection is 
due to hereditary syphilis. The next most important causes 
are acquired syphilis, malaria and other infectious diseases, 
such as cholera, enteric fever and scarlet fever. Gout and 
rickets also give rise to it. The disease may begin without 
prodromes, except in the case of topers who present a long 
history of gastro-intestinal catarrh. Early in the course of 
the affection there may be some slight enlargement of the 
liver. In the fully established disease the organ is dimin- 
ished in size. Of decided diagnostic import is an early atro- 
phic change in the right lobe of the liver, which in some cases 
can scarcely be felt in the abdomen. Jaundice is absent as a 
rule. The most characteristic symptoms relate to the disturb- 
ance of the circulation in the portal vein, or to the diminished 



PRACTICE OF MEDICINE. 617 

function in the atrophied cells of the liver, or they depend 
upon a combination of these two conditions. One of the most 
prominent signs is ascites. Even before this the effect of 
congestion of the mucous membranes of the stomach and 
bowels may be noted by hematemesis and enterorrhagia, which 
occur in the course of this affection. Hemorrhoids occur. 
The spleen is enlarged. The cutaneous veins of the abdomen 
are often greatly enlarged. The urine is diminished in 
amount and is of low specific gravity, frequently reddish in 
color. The temperature is normal or subnormal. The gen- 
eral nutrition suffers greatly, and the patient loses flesh. The 
treatment consists in abstaining from alcohol. Potassium 
iodide and mercury are of use in the syphilitic form. The 
bowels should be carefully regulated, and when ascites be- 
comes prominent, paracentesis abdominis becomes necessary. 

Give the etiology of tetanus. 

The disease occurs in either sex and at any age. It may 
result from a wound in any part of the body, and sometimes 
without apparent trauma. It occurs most often from wounds 
that are exposed to dirt and filth. The exciting cause is the 
bacillus of tetanus described by Kitasato. 

Give the treatment of sciatica. 

Rest by means of splinting the limb is important. Atten- 
tion must be directed to the cause of the disease. If of rheu- 
matic origin the salicylates are of value. Phenacetine, anti- 
pyrine and other members of the coal-tar group are of value ; 
in severe cases, however, morphine is necessary. Surgical 
measures should only be resorted to after all forms of medical 
relief have failed. 

State the varieties, causes and prognosis of angina pec= 
toris. 

True angina pectoris and pseudo angina pectoris. Occlu- 
sion of the coronary arteries and sclerosis are important fac- 
tors. The true form occurs after middle life, and in the male 
sex ; the pseudo form occurs most frequently in young women, 



618 PRACTICE OF MEDICINE. 

in connection with hysteria and neurasthenia. The prog- 
nosis in the true form is very unfavorable ; in the pseudo form 
it is favorable. 

How should insolation (sunstroke) be treated? 

The treatment of thermic fever consists in the application 
of cold to the surface of the body, preferably in the form of 
an ice bath or ice rubbing. The cold pack is sometimes sub- 
stituted. The bath is commonly continued until the temper- 
ature reaches the normal point. Ice water enemata may also 
be employed. Measures should also be taken to guard the 
heart. For this purpose strychnine, digitalis and alcohol 
are useful. 

Give the treatment and prognosis of erysipelas. 

Cold water should be liberally administered to the patient, 
and cold sponging, especially if the temperature is high, is of 
distinct advantage. Ice cloths are also the best treatment 
for the eruption. They should be frequently renewed. An 
ointment of ichthyol and lanolin is also used for this purpose. 
The administration of tincture of the chloride of iron in full 
doses is the general method of treating erysipelas. When 
the nervous symptoms become prominent, or if in the aged or 
cachectic, bold stimulation is necessary; alcohol is best for 
this purpose. If the pain be severe morphine should be re- 
sorted to. Anti-streptococcic serum may be beneficial, and 
should always be resorted to in malignant cases. 

In simple, uncomplicated cases occurring in those in pre- 
vious good health the prognosis is favorable. The prognosis 
should be regarded as serious when erysipelas occurs as a 
complication of any other malady, or when it results from 
surgical accidents or occurs in the puerperal state. It is 
always serious in alcoholics and cachectics. 

State the etiology and prophylaxis of biliary calculi. 

In a majority of cases they are found in persons of thirty 
and over, and they occur more frequently in the female than 
in the male sex. Catarrh of the bile-ducts and gall-bladder 



PRACTICE OF MEDICINE. 619 

may lead to stagnation of bile and to an increase in the amount 
of cholesterine. Farinaceous foods may give rise to the for- 
mation of gall-stones; in diseases in which nitrogenous food 
is largely partaken of, as in diabetes, gall-stones are rarely 
found. They are formed most frequently in the gall-bladder. 
They may occur in the larger gall-ducts, and, rarely, even in 
the smaller biliary passages of the liver. The prophylaxis 
consists in appropriate diet, exercise and general favorable 
hygiene. In women tight lacing should be avoided. "Warm 
baths, regular exercise in the fresh air, etc., should be recom- 
mended. The patient should avoid indulgence in sweets and 
starchy foods. Constipation should be corrected. This may 
best be done by the use of waters, such as Carlsbad. Massage 
has been strongly advised. 

What is chronic hydrocephalus? 

As a rule the child's head begins to increase in size soon 
after birth, or it may even be greatly enlarged at birth. There 
is irritability and restlessness, and much impairment of the 
general nutrition; the child does not grow as is usual with 
normal children, even though the appetite be good. Mental 
development is tardy, and as a rule the child does not learn 
to walk. Ocular phenomena are present, such as strabismus, 
and occasionally optic atrophy. Within a few years vomiting, 
coma and convulsions appear. Death usually takes place 
from exhaustion. 

Give the etiology and treatment of anthrax. 

This is a widespread disease in animals, occurring all over 
the world. The affection is conveyed to man as the result of 
the handling of wool or hides, rarely by direct inoculation 
from the bites of insects that have fed on animals that have 
died of the disease. It is a very rare affection in man. Cer- 
tain occupations predispose to it, such as those of stablemen, 
tanners, butchers, shepherds and wool-sorters. The exciting 
cause is the bacillus of anthrax. It is important that the 
pustules should be treated surgically, the site of inoculation 



620 PRACTICE OF MEDICINE. 

being destroyed by bichloride of mercury, carbolic acid or the 
actual cautery. Constitutional treatment consists in the use 
of quinine, iron, strychnine and alcohol. 

Give the treatment of catarrhal pneumonitis. 

"When the temperature becomes high, cyanosis shows itself 
and somnolence is threatened, and a warm bath with cold effu- 
sion to the head is useful. Alcohol is valuable as a circulatory 
stimulant. Inhalations of steam are of value. In strong 
children in whom there is great secretion in the bronchial 
tubes which is brought up with difficulty, emetics may be used 
from time to time, but these should not be continued through- 
out the course of the disease. It is dangerous to administer 
narcotics to young children. Stimulating expectorants, such 
as the salts of ammonia, are often useful. Minute doses of 
strychnine and inhalations of oxygen are of benefit. A mild 
purge at the onset frequently gives great relief. The diet 
should be a light and nutritious one. 

What is the prognosis as to the cure of epilepsy? Give 
the treatment of epilepsy. 

True epilepsy is an incurable affection. Much may be done 
to diminish the number and severity of the attacks, but a true 
cure is rarely met with. In the treatment it is important to 
relieve the cause if possible. It is best to endeavor to treat 
the epileptic in a colony, in which he may have an out-door 
occupation. The bowels should be regulated, the diet should 
consist of meat sparingly, fruit, cereals and vegetables. The 
best results have been obtained from the use of the bromides. 

What cutaneous diseases may occur as complications of 
saccharine diabetes? 

Boils, carbuncles, erythema, eczema, especially of the geni- 
tals, purpura, cellulitis and gangrene. 

What is hemophilia? How should it be treated? 

This is a disease characterized by a tendency to hemorrhage, 
which is often uncontrollable, and it is due to a deficiency in 



PRACTICE OF MEDICINE. 621 

the coagulability of the blood. The coagulation is retarded, 
and frequently in this condition the blood does not coagulate 
in less than from thirty to fifty minutes. The prophylaxis is 
important ; wounds and operations should be avoided in a per- 
son suspected to be a bleeder. When the bleeding is from a 
free surface and easy of access, compression and rest should 
be tried. Ice, locally, is of value. Calcium chloride and per- 
chloride of iron are recommended by many. Gelatine, collo- 
dion and extract of the suprarenal capsule may be found 
useful when applied to the bleeding surface. Freshly drawn 
blood from a healthy person may be employed as an appli- 
cation. 

Describe the treatment of purulent pleurisy. 

The aspirator should be used, and drainage should be as 
free as possible. If the pus does not flow through the needle 
a surgical operation is necessary. 

Describe the treatment and prophylaxis of nephrolith= 
iasis. 

The treatment consists in relieving the pain during an 
attack of renal colic, which is best accomplished by a hypo- 
dermic of morphine or by the inhalation of chloroform. Hot 
baths and hot fomentations to the loins are useful. Fluids 
should be freely partaken of. For uric acid calculi, piper- 
azin, urotropin, and the salts of lithia are of value. The 
waters of various mineral springs are valuable, such as Carls- 
bad, Ems, Kissingen. Surgical interference is sometimes 
necessary. 

How should cholera morbus be treated? 

Absolute rest in bed is necessary. Food should be given 
sparingly, and it had better be withheld for some time if 
vomiting be frequent. Sterilized milk and animal broths may 
be administered sparingly. Local sinapisms and hot turpen- 
tine stupes are of benefit to allay vomiting. At the onset of 
the disease it is 'good practice to give a purge. The remedy 
for the condition is opium in some form. Later in the course 



622 PRACTICE OF MEDICINE. 

of the affection bismuth and antiseptics which act on the 
intestinal tract are of value. 

What is the treatment of spasmodic stricture of the 
esophagus? 

Dilatation with the esophageal bougie is of value. Remedies 
to act upon the nervous system and tonics are of use. The 
general hygiene of the patient should be carefuly looked 
after. 

Give the treatment of hematemesis. 

Absolute rest in bed. Food and drink should be stopped. 
For the thirst small pellets of ice may be taken in the mouth. 
Opium and ergot hypodermically are the best remedies. 

Describe the treatment of rachitis. 

The child should have the best of food, and if the mother 
cannot nurse it a wet-nurse should be procured. Abundance 
of fresh air and sunshine are essential. Daily warm bathing 
is necessary. The child should not be encouraged to walk. 
The remedies that have proven most effective are phosphorus, 
cod-liver oil and the syrup of the iodide of iron. 

Give the treatment of ulcer of the stomach. 

Rest in bed is most important, even in the mildest cases. 
Food should be withheld from the stomach for some time, rec- 
tal alimentation being resorted to. Milk is the best food, and 
may be given either hot or cold. External applications over 
the stomach, such as hot poultices frequently renewed, are of 
value. Among the most useful of the many drugs that have 
been recommended is bismuth; this remedy should be em- 
ployed in large doses. Salol, oxide of silver, carbonate of 
soda, carbolic acid and cocaine are also highly recommended. 
If there be great pain opium, and sometimes cannabis indica 
are useful. 

Give the symptoms of (a) acute lead poisoning, (b) 
chronic lead poisoning. 

In acute lead poisoning the symptoms may come on in a few 



PRACTICE OF MEDICINE. 623 

weeks. Rapid and marked anemia is usually the earliest 
symptom. Constipation, which, is followed by excessive diar- 
rhea, vomiting, abdominal tenderness and distension are pres- 
ent. The abdomen, as a rule, is hard and distended. There 
is colic of the severest type over the entire abdomen. The 
paroxysms are of gradual onset and increase in severity. The 
pain is relieved by deep pressure. The temperature, as a rule, 
is subnormal. The symptoms of chronic lead poisoning are 
due to the prolonged absorption of lead in small quantities. 
The anemia may be profound, showing a marked decrease in 
the red blood-cells, with a corresponding decrease in the hem- 
oglobin. There is wasting of the muscles and a peculiar yel- 
low complexion, which, however, is not due to the deposit of 
bile pigment. Along the border of the gums, usually most 
marked under the incisor teeth, is a bluish-black line. Tre- 
mors occur from time to time. There is a metallic taste in the 
mouth, coated tongue, fetid breath, marked dyspepsia and 
obstinate constipation. Lead colic is particularly marked. 
The pain, as a rule, is more severe in the afternoon and at 
night. Occasionally paroxysmal pains occur in the joints 
without swelling, redness or fever. An important symptom 
is lead paralysis. This most frequently occurs as wrist-drop, 
the extensors being particularly affected. Occasionally cere- 
bral symptoms develop, this condition being known as lead 
encephalopathy. 

Give the treatment of suppurative hepatitis. 

The treatment consists in the early evacuation of the ab- 
scess in suitable cases. Purging with calomel or salts is 
recommended. Opium is best to relieve pain. When the 
septic phenomena are marked, free stimulation should be re- 
sorted to, whiskey and strychnine giving good results. Qui- 
nine is often of use. For the anemia, iron and arsenic should 
be administered. The diet should be light and nutritious. 

What is uremia and how should it be treated? 

Uremia is a clinical condition due to acute or chronic dis- 



624 PRACTICE OF MEDICINE. 

ease of the kidney or of its conducting apparatus. Depend- 
ing upon whether the symptoms arise rapidly or suddenly or 
whether they are more insidious, the condition is known as 
acute or chronic uremia. In the treatment it is important to 
withdraw the urine. In young subjects with slow pulse and 
high arterial tension bleeding is indicated, and should be fol- 
lowed by hypodermoclysis of a normal salt solution. Intra- 
venous injections of a normal salt solution are often indicated. 
Purging by croton oil and broken doses of calomel is useful. 
For the convulsions, chloral and morphine hypodermically 
are the most reliable agents. Sweating should be induced by 
a hot pack or by some similar method. The administration 
of pilocarpine is accompanied with danger on account of its 
depressing effect upon the heart. 

How should acute nephritis accompanying or following 
scarlet fever be treated? 

Absolute rest in bed is important. It is well to put the 
patient on an absolute milk diet. Some of the alkaline min- 
eral waters, such as Seltzers and Vichy, may be mixed with 
the milk. Daily sponging with warm water and gentle fric- 
tion of the skin are of use. Calomel in fractional doses is 
useful, which may be followed by a saline, even if there be no 
tendency to constipation. Some of the diuretics may be used, 
such as citrate of potash or benzoate of soda. Iron in some 
form is useful, and Basham's mixture is often administered. 

How should edema of the glottis be treated? 

The treatment is 'that of dropsy occurring in other parts of 
the body. Surgical treatment, such as scarification, intuba- 
tion, tracheotomy, etc., is often necessary. 

Name one important complication and one important 
sequel of typhoid fever. 

An important complication of typhoid fever is hemorrhage 
from the bowels. An important sequel is phlebitis, which 
most frequently occurs in the left leg. 



PRACTICE OF MEDICINE. 625 

Outline a plan of treatment of typhus fever. 

The prophylaxis is of the greatest importance. An abund- 
ant supply of good food, fresh air and free ventilation are 
important. Stimulation is necessary on account of the severe 
prostration. If hyperpyrexia occur the cold bath should be 
resorted to. Strychnine may be necessary as a respiratory 
and cardiac stimulant. Complications are treated as they 
arise. The constipation must be relieved by enemata, and in 
convalescence tonics should be administered. 

Give the treatment of pyelitis. 

The patient must be kept in bed and protected against cold. 
A bland diet should be given and the alkaline mineral waters 
freely used. Application of heat to the renal region should 
be resorted to. Warm baths are grateful to the patient. 
Opium in some form to relieve the pain is necessary. In 
chronic pyelitis astringents are indicated, such as acetate of 
lead. Salol and methylene blue are sometimes found of ben- 
efit. Surgical interference is necessary if hydronephrosis or 
pyelonephrosis is present. 

Mention the most reliable remedy for pulmonary hem= 
orrhage. 

Rest in bed, abstaining from food and drink, an ice-bag 
applied to the chest, and opium and ergot. 

What remedies should be used in hemorrhage from 
mucous surfaces? 

Opium, ergot and suprarenal capsule. 

What are the complications and sequelae of whooping 
cough? 

Hemorrhages occur, such as petechia?, about the face and 
neck ; epistaxis and hemoptysis may occur ; broncho-pneumonia 
is a complication which adds greatly to the gravity of the 
case. Pulmonary tuberculosis is comparatively frequent in 
a considerable proportion of the cases, especially in adoles- 
cents. 

40 



626 PRACTICE OF MEDICINE. 

Describe the treatment of paralysis agitans. 

The treatment is purely symptomatic. Occasionally hyos- 
cyamin or hyoscin control the tremor. The general hygiene 
of the patient is to be looked after ; tonics, such as arsenic and 
strychnia, are of use. 

What are the causes of peritonitis? 

The most frequent mode of infection is through the intes- 
tines and from the female generative organs. Various forms 
of ulcer may produce peritonitis, such as the typhoid or tuber- 
cular ulcer. Malignant disease of the intestine may give rise 
to it. It also arises from forms of intestinal obstruction, such 
as volvulus and stricture. The gall-bladder and liver may 
be the sources of infection, and particularly abscesses, and 
syphilitic disease may give rise to it. Obstruction of the 
biliary passages by gall-stones may produce it. The affection 
may arise from the spleen, through an infected embolus. It 
may occur from infective disease of the kidney, from disease 
of the bladder wall, from the prostate and from the urethra. 
Peritonitis occasionally occurs in the course of some of the 
acute infectious diseases, such as erysipelas, acute rheumatic 
fever and septicemia. 

Name the places where yellow fever is endemic. 

The disease is endemic in the West Indies, parts of the 
Mediterranean coast, South America and Africa. 

What treatment would you recommend for diphtheritic 
paralysis? What is the prognosis? 

Rest, tonics, strychnia, and later, electricity are useful. 
The prognosis in all forms of diphtheritic paralysis is favor- 
able as a rule, except in paralysis of the heart. 

What are the causes and treatment of acute myelitis? 

Exposure to variations of temperature, especially to cold, is 
important. Thus certain occupations predispose, such as engi- 
neers, cabmen, drivers, etc. Gout, rheumatism and certain 
metallic poisons, such as lead, mercury and arsenic, have been 



PRACTICE OF MEDICINE. 627 

recognized as etiologic factors. Alcohol may also be a cause. 
Syphilis usually gives rise to the chronic form. Occasionally 
acute myelitis may be secondary, resulting from extension, as 
in abscess, caries or cancer of the spine. Traumatism is per- 
haps the most common cause. The puerperal period and the 
existence of septic conditions have also been noted as causes of 
the disease. In the treatment, counter-irritation by blisters or 
the application of cold are of use in the acute stage, but they 
are contra-indicated after this stage. Precaution should be 
taken not to interfere with the nutrition of the skin on account 
of the great liability to trophic changes. Absolute rest is 
important. Great care must be taken of the bladder. The 
catheter should be carefully sterilized. Electricity is benefi- 
cial late in the course of the disease, and at this time massage 
is also valuable. A warm climate favors improvement. Hy- 
drotherapy has been highly recommended. General tonics 
are of use ; the bowels may be moved by enemata. In syphi- 
litic cases anti- syphilitic treatment is indicated. 

What are the complications and sequelae of scarlet 
fever? 

Diphtheria and nephritis are the most important complica- 
tions, and occur in nearly all severe cases. Endocarditis 
occurs; less commonly pericarditis. Meningitis, peritonitis, 
pleurisy, with and without effusion, also occur. Among the 
most common sequels are enlarged lymphatic glands, chronic 
joint affection, the hemorrhagic diathesis, monoplegia, hemi- 
plegia, peripheral neuritis, hysteria and anemia. 

On what symptoms would you base a diagnosis of ty= 
phoid fever? 

Upon the slow onset, with a gradual rise in temperature, 
nose-bleed, headache, diarrhea, the occurrence on or about the 
seventh day of the typical eruption, enlargement of the spleen, 
dilated pupils, the Widal reaction, and the dicrotic pulse. 

How should scarlatina be treated? 

Strict isolation is important. The scales during the period 



€28 PRACTICE OF MEDICINE. 

of desquamation should be carefully collected and burned. 
The diet should be nutritious and easily assimilated. Pure 
drinking water or the alkaline mineral waters may be freely 
administered. Milk is a necessary article of diet. There is 
no specific treatment. A mild laxative should be given at the 
onset. Tepid sponging, at least twice daily, is necessary in 
severe cases. "Warm bathing is usually very grateful to the 
patient. During the period of eruption an animal fat, used 
as an inunction to the skin, prevents itching and hastens des- 
quamation. A mild diuretic may be used, and it is important 
to keep the kidneys active. Complications must be treated 
upon general principles. 

What should be done for a patient during the passage of 
a biliary calculus? 

Hot fomentations should be applied over the lower part of 
the liver. If the pain is severe, whiffs of chloroform may be 
inhaled. However, in the majority of the cases relief of the 
pain only follows the hypodermic use of morphine. If the 
condition is not relieved by medical means surgical interfer- 
ence must be resorted to. 

How should small=pox be treated? 

Vaccination should be practiced as a prophylaxis. Com- 
plete isolation and disinfection are absolutely necessary. 
There is no specific treatment. Food is not well borne at first, 
and there may be much vomiting and diarrhea. Usually acid 
drinks or small particles of ice are grateful to the patient. 
From the onset of the disease detergent washes containing 
antiseptic solutions should be used for the mouth. The room 
should be darkened; the solar light being rigidly excluded. 
This prevents pitting. Warm baths two or three times 
daily are of decided benefit to the patient. During the 
time of secondary fever bold stimulation is necessary. At 
the onset a laxative is useful. Pain should be overcome by 
small doses of opium, but great care must be exercised with 
this drug, as it tends to lock up the secretions. Restlessness 



PRACTICE OF MEDICINE. 629 

and insomnia should be treated by trional and sulphonal. In 
convalescence tonics are useful. 

What is the treatment for angina pectoris? 

For the attack, hypodermics of morphia are necessary. In- 
halations of amyl nitrite or nitroglycerin in full doses may 
prove beneficial. In the interval between the attacks the 
patient must lead a quiet life. The functions of the body 
should be well looked after, and the administration of the 
nitrite of sodium with strychnine is of use. 

What should be done to give relief in intestinal obstruc= 
tion? 

The treatment is largely surgical. Opium should be given 
to relieve the pain. If vomiting be persistent the stomach 
tube may be used. Purgatives should be avoided. Hot tur- 
pentine stupes may be applied to the abdomen. Rectal feed- 
ing may be resorted to, but surgical interference sooner or 
later becomes imperative. Atropine in large doses hypoder- 
mically has been lately advised. 

What causes cerebro=spinal meningitis, and how should 
it be treated? 

The exciting cause is the diplococcus intracellularis menin- 
gitidis, described by Weichselbaum in 1887. The treatment 
is purely symptomatic. Cold applications to the head and to 
the spinal cord are useful. On the other hand, heat to the 
head and spine may be preferred by some patients. A laxa- 
tive dose of calomel early in the course of the disease and 
mercury throughout the entire affection has many advocates. 
Opium perhaps offers the best mode of treatment, and there 
is a remarkable tolerance for this drug even in the very 
young. If vomiting be a prominent symptom morphine 
should be given hypodermically. Chloral, the bromides and 
cannabis indica have been used, but in effect cannot be com- 
pared with the systematic use of opium. Alcohol is necessary 
when depression shows itself and asthenia is marked. 



630 PRACTICE OF MEDICINE. 

Describe the treatment of pericarditis. 

In the first stage ice-bags applied over the preeordium are 
of use in relieving pain and quieting the cardiac action. 
Small blisters at some distance from the preeordium are of 
benefit, especially when there is an effusion. If pain be 
severe opium in some form is necessary. In very large effu- 
sion paracentesis is necessary, especially so if the effusion be 
purulent, in which condition surgical interference is impera- 
tive. Gentle purges from time to time are useful. A mild, 
non-stimulating diet is indicated. 

How should apoplexy due to cerebral hemorrhage be 
treated? 

The patient must be placed in bed with the head elevated. 
If arterial tension be high venesection should be performed 
immediately. Ice-bags are applied to the head. Croton oil 
or calomel is of great value in inducing free purgation. If 
the patient be unconscious for a considerable length of time 
the bladder must be evacuated with a catheter. 

What is the treatment of diarrhea occurring in typhoid 
fever? 

Large doses of bismuth, salol and some of the intestinal 
antiseptics are of value in this condition. Opium must be 
administered with great caution. 

Give the treatment of whooping=cough. 

Food should be abundant and nutritious, and if the child 
vomits during a paroxysm nourishment should be immediately 
readministered. Antipyrine in doses proportionate to the 
age of the patient has some influence on the paroxysms. 
Bromoform is of use, but is very likely to give rise to nausea. 
Good hygiene is essential in the treatment of the case. 

What measures should be adopted in the treatment of 
pulmonary edema? 

The treatment is largely that of the primary disease which 
causes the edema. There should be active purging, especially 



PRACTICE OF MEDICINE. 631 

if cyanosis be absent. Hypodermics of atropia in large doses 
frequently repeated have been found of use in some cases. 

How should endocarditis be treated? 

The treatment consists in absolute rest in the recumbent 
posture. Digitalis should only be given for definite and fixed 
indications, and is not required unless the pulse becomes quick 
and small or irregular, or the signs of failing compensation 
occur. Strychnia is of benefit in this condition. If anemia 
persists, iron with quinine and arsenic will be found valuable. 

What measures should be employed to rid the system of 
tape=worm? 

The most reliable anthelmintics are the male fern, the pome- 
granate root, bark and its alkaloid pelletierin, kousso, pump- 
kin seed, turpentine and chloroform. Thymol is also highly 
recommended by some authorities. Before the administration 
of any of these drugs the patient should be put upon a milk 
diet for at least twenty-four hours. It is then desirable the 
night before the vermifuge is administered to give a brisk 
cathartic, preferably calomel. Early the following morning 
the anthelmintic is administered, and a few hours afterward 
another purgative. 

What are the ordinary age limits of typhoid fever, and 
what conditions are essential to its production? 

The age at which enteric fever most frequently occurs is 
from 15 to 30. The predisposing causes are temperate cli- 
mate, autumn months, unfavorable hygienic surroundings, 
such as infected drinking water, food, sewage and poor drain- 
age. The exciting cause is the bacillus of Eberth or the ba- 
cillus typhosus. 

How does the cause of typhoid fever principally gain 
entrance to the human body? Outline the prophylaxis. 

Most frequently through the digestive tract in the form of 
infected drinking water or milk. The prophylaxis consists 
in the absolute destruction of the discharges and disinfection 



632 PRACTICE OF MEDICINE. 

of the soiled linen. The drinking water should be boiled, and 
suspected milk should also be boiled. 

Describe the treatment of cancer of the stomach. 

The most important point in the treatment relates to the 
early diagnosis, with the hope of operative interference. 
Medical methods are only palliative. They consist in allevi- 
ation of the dyspeptic conditions and the pain. To accom- 
plish these ends systematic lavage and the use of opium are 
the most satisfactory agents. Strength may be maintained 
by rectal alimentation. 

Give the period of incubation and the treatment of 
mumps. 

The period of incubation is about two weeks. It may be as 
long as three weeks. In the treatment the patient should be 
isolated, and a mild laxative given at the onset. Rest in bed 
is important. Attention should be given to the alleviation 
of pain. 

Describe herpes zoster and its treatment. 

One or more groups of small vesicles seated upon a plane 
base and attended by neuralgic, burning pain, occuring along 
the course of one or more branches of a nerve, is known as 
herpes zoster. The process is acute and self-limited. Mild 
cases rarely require any constitutional treatment. In the 
more severe cases remedies which invigorate the nervous sys- 
tem are of value. Zinc phosphid every three or four hours 
seems to be of service, and in some cases quinin and strychnin 
are useful, also arsenic. If the pain be very severe opium in 
some form is useful. Antipyrin, phenacetin and salicylate 
of sodium have been highly recommended. A dusting powder 
consisting of oxid of zinc, boric acid and talc should be ap- 
plied over the vesicles. This may be changed daily or every 
few days. 

Give the symptoms and treatment of exophthalmic 
goitre. 

The four cardinal symptoms of exophthalmic goitre are 



PRACTICE OF MEDICINE. 633 

enlargement of the thyriod gland, protrusion of the eyeball, 
tachycardia and tremor. Hydrotherapy is often valuable ; 
rest in bed and ice-bags applied to the precordium give much 
relief to the patient. Digitalis, aconite, veratrum viride, 
tincture of strophanthus and potassium bromid have been 
employed in this disease. Thyroid extract has also been lately 
recommended. Eemoval of the thyroid gland has been prac- 
ticed with but little benefit. 

Name five diseases caused by a known germ. 

Tuberculosis, enteric fever, cholera, plague and diphtheria. 
Describe the treatment of neurasthenia. 

The study of the individual case is important. The rest 
cure is applicable in many cases, while in others a change of 
climate is of great benefit. Hydrotherapy, electricity, mas- 
sage and hypnotism have all been of value in the treatment. 
The diet must be easy of digestion. In the cerebral variety 
the bromids are valuable. In the gastric variety arsenic in 
the form of Fowler's solution is of service. Syrup of the 
hypophosphites and valerian, caffeine, hyoscin and phenacetin 
are of benefit in suitable cases. Opium and other hypnotics 
must be used with great caution. Iron and cod-liver oil are 
useful. Systematic exercise is of great benefit. 

Give the morbid anatomy and physical signs of acute 
endocarditis. 

The lesions are usually situated in the left side of the heart. 
The endocardium lining the valves is most frequently affected. 
The lesions are small vegetations varying in size from one to 
four millimeters in diameter. Usually micro-organisms are 
associated with simple endocarditis. Microscopically the first 
change noted in the endocardium is the granular degeneration 
of the epithelial cells. In the sub-endothelial tissues blood- 
vessel changes that accompany inflammation are noted. Co- 
agulation necrosis and the proliferation of the fixed cells 
are found. The inflammatory exudate, the sub-endothelial 
tissues and the fibrin upon the free surface cause the bulging 



634 PRACTICE OF MEDICINE. 

or warty excrescences. Upon this projection, fibrin from the 
blood stream is also deposited. Intermingled with the exu- 
date the various micro-organisms may be present. Early on 
inspection no change is usually noted, and the important 
physical signs can only be discovered upon auscultation. As 
the mitral valve is most frequently involved, a systolic mur- 
mur, which has its maximum intensity at or near the apex, 
and is transmitted to the left axilla, and often to the angle 
of the scapula, shows that mitral regurgitation has taken 
place. The murmur is at first soft and blowing in character. 
When other valves are implicated murmurs related to them 
occur. 

Mention the causes and symptoms of gastralgia. 

The condition consists in severe boring, rumbling, painful 
contractions in the epigastric region extending from the 
xiphoid cartilage and radiating to the back, 'accompanied by 
syncope and signs of collapse. The condition may appear 
suddenly without apparent cause, or may be due to slight 
pressure in the epigastrium. It may be accompanied by the 
sensation of the globus hystericus, bulimia, frequent micturi- 
tion and vomiting. It disappears after having lasted a few 
moments. The attacks occur with marked irregularity, occa- 
sionally several taking place in one day, upon alternate days, 
or not recurring for months. It is a neurosis of the stomach. 

Describe the treatment of leukemia. 

Rest in bed is desirable, and a nutritious diet should be 
given. Arsenic should be administered early, and the dose 
increased to the point of tolerance. This drug seems to have 
a marked beneficial effect. Ergot has been recommended; 
bone marrow and iron are also found to be useful, especially 
when arsenic is not well borne. Oxygen inhalations may be 
beneficial. 

Describe the symptoms and treatment of multiple 
sclerosis. 

The first symptoms may appear after some mental or phys- 



PRACTICE OF MEDICINE. 635 

ical strain, the patient behaving as if affected by hysteria. 
There may be temporary aphonia, from which there may be 
speedy recovery, or numbness may occur in some part of the 
body. These symptoms may disappear for a time and re- 
appear with increased severity. Charcot has given the fol- 
lowing description: The patient develops spastic paraplegia 
with exaggerated reflexes, with ankle clonus and limited 
movements. An irregular jerky tension tremor occurs, nys- 
tagmus being a prominent symptom. Diplopia and paralysis 
of the ocular muscles are common. Scanning speech is prom- 
inent. There are paras thesia, tinnitus aurium and vertigo. 
The mental faculties are blunted, and in some few cases apo- 
plectiform and epileptiform convulsions occur. Trophic 
changes arise late in the disease, the sphincters, however, 
remaining normal. The treatment is the same as in other 
forms of sclerosis. The salts of gold, silver and arsenic have 
been recommended. 

Describe the eruptions in the eruptive fevers. State 
where they first appear and the time of their appearance. 

In scarlet fever the eruption occurs at the end of the first 
day or beginning of the second day. It consists of pin-head 
points appearing first upon the neck and chest and spreading 
rapidly all over the body, except certain parts of the face, the 
mouth and chin. These red points, which are close together, 
soon coalesce, giving a diffuse pinkish or reddish appearance 
to the entire skin, which presents a boiled lobster color. Some 
slight edema may also be noted. Throughout the entire erup- 
tion raised papules are found. The eruption lasts about four 
or five days, and disappears by desquamation. The eruption 
in measles occurs upon the fourth day. It appears first upon 
the face and neck, and spreads rapidly over the entire body 
The eruption consists of rose-red or brownish maculo-papular 
points raised above the skin, with intervening healthy skin, 
often arranged in a crescentic shape, especially upon the fore- 
head and wrists. The eruption remains at its height for about 
four days. The eruption in rubella appears upon the first 



636 PRACTICE OF MEDICINE. 

day, and occurs irregularly over the face, neck, chest, body 
and limbs, varying in individual cases and in different epi- 
demics. The multiform eruption may resemble erythema, 
urticaria, and in some cases that of true measles or scarlet 
fever. It may be confluent or diffuse, lasting from two to 
four days. The eruption in small-pox occurs upon the third 
day. The temperature falls as the eruption occurs. The 
eruption may be discrete or confluent. At first the rash is 
about the size of a pin-head, and soon becomes hard, feeling 
like a shot under the skin. The macular eruption is rapidly 
converted into a papule of a reddish color. There may be 
itching and burning attending these early eruptive symptoms. 
In from twenty-four to forty-eight hours the rash has invaded 
the entire body. The earlier papules soon become vesicular, 
this change taking place about the sixth or seventh day from 
the onset of the attack. In a day or so the fluid becomes 
turbid and purulent, the top being held down (primary um- 
bilication). In from twenty-four to forty-eight hours this 
umbilication has disappeared, the top now being conic in 
shape. About this time an intense red inflammatory areola 
is noticed about the base of the pock, and the eruption is now 
exceedingly painful. On or about the ninth day from the 
beginning of the disease suppuration begins in the pock, last- 
ing about three days, when the apex of the cone drops in, due 
to the absorption of the contents of the pock (secondary um- 
bilication). When absorption has been completed a crust 
forms that may remain for some days, these crusts falling off 
on or about the sixteenth day from the beginning of the dis- 
ease, leaving depressed striated scars. The eruption in vari- 
cella occurs upon the first day, and marks the beginning of 
the disease. The exanthem shows itself as a small reddish 
point or papule, which in a very few hours becomes a vesicle. 
It is 'slightly elevated above the skin rather than having the 
appearance of being under the skin ; the vesicles are thin and 
transparent, and from one-eighth to one-quarter of an inch 
in diameter. There is usually no areola. In the course of a 
few hours the vesicle becomes milky and begins to shrivel, 



PRACTICE OF MEDICINE. 637 

with depression at the top from absorption of its contents. 
This results as a yellowish-brown crust that in about ten days 
from the beginning of the attack, and even before this, sepa- 
rates, leaving a more or less well-defined scar, which in some 
cases, especially upon the face, remains permanently. The 
pocks may appear upon the face, neck, scalp, wrist and some 
parts of the body. 

Give the symptoms of acute pericarditis. 

It is impossible to diagnosticate a true pericarditis by 
symptoms without a careful physical examination. The dis- 
ease commonly begins with severe pain in the region of the 
precordium. The pulse rate increases, and may be from 90 
to 160 per minute. In some cases it may be normal, or when 
effusion occurs the pulsus paradoxus occurs. Fever of some 
degree is usually present. The most important sign is a fric- 
tion sound, which varies greatly in intensity. It is limited 
to the precordial area, and is heard most frequently at the 
base of the heart. It is increased by pressure with the stetho- 
scope. If an effusion develops the friction sound disappears, 
and returns again as absorption takes place. 

What are the complications and sequelae of cerebro= 
spinal fever? 

The important complications are broncho-pneumonia, bron- 
chitis, croupous pneumonia, endocarditis and pericarditis. 
The sequels are exceedingly common. They consist in affec- 
tions of the special senses. There may be loss of sight, per- 
manent deafness, loss of smell, loss of taste, various forms of 
paralysis and neuralgia. 

Describe the eruption of typhus fever. 

The characteristic eruption of typhus appears upon the 
fifth day of the disease, and in its early stages closely resem- 
bles measles. Macular spots of irregular size and outline, 
and of a dirty pinkish or reddish color, characterize the ex- 
anthem. It appears first upon the chest and abdomen, and 
extends to the extremities, the face being rarelv affected. It 



638 PRACTICE OF MEDICINE. 

is particularly copious upon the extremities, where later in 
the disease it becomes darker or petechial. Another erup- 
tion is also characteristic, and consists of marbling or mottling 
of the skin. This rash lasts throughout the disease, and does 
not disappear in death. 

Describe the treatment of measles. 

There is not specific treatment, and in uncomplicated cases 
medicines are unnecessary. A mild laxative at the onset is 
useful. The entire treatment should be directed to the pre- 
vention of complications, especially broncho-pneumonia. When 
complications occur they must be treated upon general prin- 
ciples. 

Give the physical signs of a cavity of the lung in pul= 
monary tuberculosis. 

If the cavity be large and superficially situated there will 
be depression upon inspection. Upon palpation, if the cavity 
be empty, there will be increased vocal fremitus. Upon per- 
cussion, if the cavity is empty, a tympanitic note may be elic- 
ited. If the cavity communicate with the bronchus a cracked- 
pot sound may occur. If the cavity be filled dulness will be 
noted upon percussion. On auscultation, if the cavity be 
empty, increased vocal resonance and cavernous breathing 
will be heard. If fluid be present in the cavity bubbling rales 
are heard. Around the cavity a friction sound is frequently 
noted. 

Give the etiology and treatment of hemothorax. 

Hemothorax may result from traumatism, caused by frac- 
ture of a rib or wounding of a lung. It may also result from 
rupture of an aneurysm, from malignant disease of the lung, 
and in the hemorrhagic diathesis. If the hemothorax be mod- 
erate in size it should not be interfered with, as subsequent 
absorption and clotting will take place. Rest and the free 
administration of opium are necessary. Avoid stimulation, 
for it will interfere with the formation of a clot. 



PRACTICE OF MEDICINE. 639 

Describe the Brand method of treatment in typhoid 
fever. 

When the temperature in the axilla reaches 102.6° F. a cold 
bath is given, and repeated every three hours, the water being 
at a temperature of about 70° F. The patient should be 
immersed in the tub, the water covering all but the head ; then 
water of a lower temperature should be poured upon the 
patient's head or a wet ice pack used. Gentle friction should 
be applied constantly by the attendants, and the patient 
should be encouraged to do likewise. The abdomen should 
not be rubbed. The duration of the bath is 15 minutes. 
Some alcoholic stimulant should be administered to the pa- 
tient before and after the bath. When the bath is finished 
the patient should be lifted back to his bed and covered with 
woolen blankets. The temperature should be taken one-half 
hour afterward to note the fall produced by the bath. 

Give the symptoms and treatment of myocarditis. 

The symptoms m»ay be entirely latent, and the condition in 
mild grades is not likely to be recognized. In the advanced 
stages pain in the preoordium, especially upon slight exertion, 
becomes prominent. It radiates and shoots down the left 
arm, and tingling may occur in the fingers. Shortness of 
breath is a prominent symptom. The apex beat is weak and 
diffused, the pulse is feeble, and often intermittent. Marked 
arrhythmia occurs. Constipation and gastric disturbances 
are common. In advanced stages edema of the skin may 
occur. The treatment consists in careful regulation of the 
diet, attention to the functions of the body, and the systemic 
use of such drug's as alcohol, strychnia, iodide of potassium 
and arsenic. 

What is the practical import of hematuria, and how can 
its source be diagnosed? 

Blood in the urine is caused by the presence of red blood 
corpuscles, the color being of a reddish hue. When blood is 
derived from the bladder the first that is passed will contain 



640 PRACTICE OF MEDICINE. 

a smaller amourut of blood than the last. Blood from the 
bladder may be copious in amount, and this urine in contrast 
to that containing blood from the kidney, upon standing, will- 
show fibrin. Blood from the kidney is more likely to be inti- 
mately mixed with the urine, and if coagula be present they 
are apt to be washed out. From the urethra only the last 
drops are likely to be bloody. 

Give the etiology of scarlet fever. 

Age is an important predisposing cause. It rarely occurs 
after the tenth year of life. Neither sex nor occupation pre- 
dispose to it. The disease is more common in cold and tem- 
perate regions. Epidemics are more prevalent in the winter. 
In this disease there is a marked personal predisposition. 
One attack confers immunity as a rule. The exciting cause 
is not known. 

Give the treatment of tic douloureux. 

It is especially important to treat the underlying condition. 
If the disease be reflex it is important to give attention to the 
affection giving rise to it. Hygienic treatment is of import- 
ance. Change of scene and residence, with good, nourishing 
diet, are necessary. Many drugs have been recommended for 
the treatment of the paroxysm, such as quinine, the coal-tar 
.analgesics, the salicylates, caffeine, aconite, gelsemium and 
belladonna. Morphine should be avoided if possible, as there 
is great danger of the patient acquiring the opium habit. 
Local treatment is sometimes of use, thus hot and cold appli- 
cations, liniments containing menthol, and occasionally elec- 
tricity may be tried. In protracted cases surgical interfer- 
ence should be thought of. 

Give the symptoms of appendicitis. 

The onset is sudden ; there is pain in the abdomen, which at 
first may be general or centered around the umbilicus, and 
occasionally in the epigastrium and in the left or right iliac 
fossa. In many cases the pain is confined to the right iliac 
fossa, and directly in the region of the appendix (McBurney's 



PRACTICE OF MEDICINE. 641 

point). If the pain is general it soon localizes itself to the 
right iliac fossa, usually within the course of twenty-four 
hours. It is paroxysmal or intermittent, and colic-like. This 
pain may be preceded by chilliness. Frequently nausea and 
vomiting mark the beginning of the attack. Fever rapidly 
follows the onset of the disease, which is usually moderate, 
from 100°-103° F. Occasionally it may be absent. The fre- 
quency of the pulse generally corresponds to the degree of 
the fever. Constipation is commonly present. The tongue 
is coated posteriorly. The facial expression of the patient 
shows anxiety and suffering. The position of the patient is 
often characteristic. The right thigh is most frequently par- 
tially flexed upon the abdomen, while the left leg is extended. 
Examination of the abdomen shows slight distension. On 
palpating the abdomen the right rectus muscle will be found 
rigid. Tenderness is as constant as pain. Pressure upon 
the opposite side produces pain in the region of the appendix. 
In some instances the appendix may be clearly made out, and 
occasionally a tumor is palpable. 

Define aphasia and give its etiology. 

Aphasia embraces a variety of defects in the use or the 
comprehension of language, either spoken or written. In the 
majority of cases aphasia is one of the symptoms of organic 
local cerebral disease, occurring in the left hemisphere in the 
right-handed, and vice versa. It occurs in cerebral hemor- 
rhage, thrombosis, embolism, abscess, tumor, and depressed 
fracture of the skull. Rarely it has been noted in hysteria 
and neurasthenia. 

Give the diagnosis and treatment of acute follicular 
tonsillitis. 

The diagnosis depends upon great pain in swallowing. This 
may be preceded by lassitude, malaise, headache, pain in the 
bones, vomiting, and marked fever. Examination of the 
throat shows redness and swelling of one or both tonsils, with 
yellowish-white patches upon them, varying in sdze from a 
41 



642 PRACTICE OF MEDICINE. 

pin-head to a split pea. These may be stripped off without 
leaving a bleeding surface, leaving an intact mucous mem- 
brane beneath. The breath is usually fetid. The patient 
should be put to bed and a laxative administered. The coal- 
tar products, especially phenacetin, in small doses, guardedly 
given, promptly relieve the pain. Ice bandages and small 
particles of ice in the mouth are useful. If pain and sleep- 
lessness persists, opium, especially Dover's powder, may be 
administered. 

Give the treatment of intestinal hemorrhage in typhoid 
fever. 

Food and drink should be withdrawn ; one or more ice-bags 
applied to the right iliac fossa, and opium given for effect. 
The head of the bed may be lowered. and the foot of the bed 
elevated. The opium should be pushed so as to produce 
mild somnolence. If thirst becomes excessive, small pellets 
of ice may be placed in the mouth from time to time. 

Give the treatment of delirium tremens. 

One of the most important features in the treatment is care- 
ful feeding. Little food should be given at a time, but it 
should be frequently administered. If vomiting is persistent, 
rectal alimentation may be resorted to. If there are signs of 
heart failure stimulants must be administered. Strychnin 
hypodermically is of great value. Every effort should be 
made to induce sleep. The most useful agents are morphin, 
hypodermically, or h'yoscin. Chloral is also useful, but it has 
a depressing effect upon the heart. 

Give the treatment and prognosis of progressive perni= 
cious anemia. 

Rest in bed is essential, and easily digested, nutritious foods 
should be given. Arsenic has been found of most value, given 
in the form of Fowler's solution in ascending doses. If this 
drug is not well borne iron may be substituted. Bone marrow 
is also useful. Stimulants, such as strychnin and alcohol, 
and inhalations of oxygen, are of advantage. The prognosis 



PRACTICE OF MEDICINE. 643 

is always grave. Death results in from a few months to a few 
years. Apparent recovery followed by relapse is common. 

Give the symptoms of acute exudative nephritis. 

The disease may begin suddenly or gradually. Edema 
develops rapidly. The urine becomes scanty and high col- 
ored, and uremic symptoms, such as vomiting and convulsions, 
occur. The edema at first is most marked in the face, partic- 
ularly about the eyelids. There is dull headache, with pain 
in the back and loins, dryness of the skin 'and dyspnea. The 
temperature is sub-febrile. The urine upon examination 
shows that it is decreased in amount, the color is dark red and 
is turbid, blood being present. The specific gravity is from 
1020 to 1030, and upon testing the urine large quantities of 
serum albumin are found. The quantity of urea is usually 
less than normal. Under the microscope hyaline, granular 
and epithelial casts are noted, with renal epithelium, red blood 
cells and granular matter. 

Define and describe bronchorrhea. 

This is a rare form of bronchitis, characterized by an exces- 
sive amount of secretion, which is very foul. It is sometimes 
called purulent bronchorrhea. The quantity of expectoration 
varies from one to three pints. The character may be either 
thin or watery or it may be transparent or ropy. Dyspnea 
and cough are always present, often being persistent and 
paroxysmal. 

Define hydronephrosis. State its causes and describe 
its treatment. 

Obstruction to some part of the ureter, bladder or urethra 
may give rise to dilatation of the pelvis and tubules of the 
kidney from accumulation of urine. It may be due to the 
twisting of the ureter, it may result from congenital narrow- 
ing of the ureter or urethra, from pressure. The treatment 
is largely surgical. Massage may be practiced with favorable 
results. However, if the condition persists, aspiration and 
drainage are necessary. 



644 PRACTICE OF MEDICINE. 

Give the symptoms and treatment of migraine. 

The principal symptom is the headache, which shows greater 
or lesser periodicity. This symptom is followed by pallor and 
some vasomotor spasm. As a rule the disease is unilateral, 
the left side being oftener affected than the right, The pupil 
upon the affected side is often smaller, and the eye may be 
retracted. Often there is disturbance of vision, the duration, 
however, being temporary. Occasionally, tinnitus aurium 
occurs, which may be associated with vertigo. These symp- 
toms are accompanied in the majority of cases by marked 
gastric disturbances, such as nausea, with frequent vomiting. 
The treatment consists in relieving the pain and the preven- 
tion of its recurrence. The following drugs have been recom- 
mended: Ergot, the coal-tar products, salicylate of sodium, 
the bromids, caffein and gelsemium. As a prophylactic, nitro- 
glycerin taken after meals with bismuth and pepsin has been 
said to be of value. Mild purging with calomel from time to 
time often prevents attacks. 

Mention a disease of the nervous system in which the 
patella reflex usually disappears; one in which it is usually 

exaggerated. 

In locomotor ataxia the knee-jerk usually disappears; in 
spastic paraplegia, as a rule, the knee-jerk is exaggerated. 

Define myxedema and give its treatment. 

This is a disease characterized by a myxomatous change in 
the subcutaneous tissues due to pathologic lesions in the thy- 
roid gland causing diminished or absent secretion. Thyroid 
extract should be administered as early as possible, and should 
be continued until all the symptoms disappear, and then a 
prophylactic dose must be given regularly. General tonics, 
such as iron, quinin and strychnia, are of value. 

Define simple acute stomatitis; at what age is it most 
common and what is its treatment? 

This is an inflammation of the mucous membrane of the 
mouth. The disease is most frequent in children, but may 



PRACTICE OF MEDICINE. 645 

also occur in adults. The treatment consists in cleanliness, 



careful feeding, and the use of a mild alkaline mouth wash. 
A mild purge is often advantageous. 

Give the causes and treatment of bronchial asthma. 

The disease is sometimes hereditary. It is more common 
in males than in females. It may follow an attack of bron- 
chitis, and is commonly associated with chronic bronchitis 
and emphysema. The inhalation of dust, the pollen of 
certain plants, fog, fumes, vapors, odors that emanate from 
certain animals may produce an attack of asthma. Reflex 
causes, as irritation from nasal polypi, causes relating to the 
gastro-intestinal tract, skin or genito-urinary center may act 
in a like manner. For the treatment of the paroxysm nar- 
cotics and anti-spasmodics are usually employed. Chloral, 
whiffs of chloroform or ether, amyl nitrite by inhalation, or 
morphia and atropia hypodermically are useful drugs. Re- 
lief sometimes follows the inhalation of nitre paper cigarettes, 
which also contain lobelia and stramonium. Sinapisms and 
turpentine stupes to the chest may be of value. 

Give the treatment of an acute attack of gout. 

A mild laxative at the onset is useful. The affected joint 
should be kept at rest, and a diet of milk and farinaceous 
articles, with plenty of water, should be insisted upon. If 
the pain become severe opium in some form must be adminis- 
tered. For the attack itself colchicum is the remedy. Iodid 
and bromid of potassium are also useful, as are also the sali- 
cylates and- the salts of lithia. 

State the prognosis in aneurysm of the thoracic aorta. 

The prognosis is always grave, death invariably resulting. 

Differentiate broncho=pneumonia and incipient phthisis. 

This is very frequently difficult, incipient phthisis often 
occurring as a localized broncho-pneumonia. Broncho-pneu- 
monia follows an acute bronchitis, making itself known by a 
rise in temperature over 103° F., by an increase in the respi- 



646 PRACTICE OF MEDICINE. 

ratory and pulse rate, the pulse commonly running from 120- 
160 per minute, while the respiratory rate may be from 40-80 
per minute. Broncho-pneumonia occurs at the extremes of 
age. The physical signs of well-developed broncho-pneumonia 
are, upon inspection, an increased respiratory rate; on palpa- 
tion, increased vocal fremitus in areas over both lungs ; upon 
percussion, localized areas of dulness over both lungs (more 
marked posteriorly) surrounded by a tympanitic area; on 
auscultation, broncho-vesicular breathing subcrepitant rales 
mixed with large and small mucous rales. The physical signs 
are all more marked posteriorly, and are usually well marked 
at the bases. 

Incipient phthisis has a gradual onset with loss of appetite, 
gastric disturbance, slight evening rise of temperature (100° 
or thereabouts), anemia and general malaise. There is, as a 
rule, slight cough with scanty expectoration (the tubercle 
bacillus may be found in the expectorated material). Occa- 
sionally there is slight hemoptysis or the sputum may be blood- 
tinged; there is a progressive loss of weight. The physical 
signs relate principally to the apices. There is a slight im- 
pairment of resonance at one or both apices on percussion, 
and upon auscultation there may be heard slight friction 
sounds, harsh breathing and some fine moist rales. 

What are the diagnostic signs of retro=pharyngeaI 
abscess? 

This may follow the infectious fevers, such as scarlet fever 
or diphtheria, usually in young children, occasionally due to 
caries of bone. There is pain on swallowing (dysphagia), 
difficulty in breathing, occasionally hoarseness, cough and 
stiffness of the neck. Upon examination of the throat by 
inspection and palpation there is discovered a fluctuating 
tumor which projects from the posterior wall of the pharynx. 

Differentiate tonic and clonic spasms. 

A tonic spasm is a continuous spasm ; a clonic spasm is an 
interrupted one, as contraction and relaxation. 



PRACTICE OF MEDICINE. 647 

Describe the characteristics and significance of the 
several kinds of arterial pulse. 

The normal radial pulse is characterized by regularity, fair 
volume, and, in the healthy adult, is from 70 to 80 per minute 
in the erect posture. The pulse of aortic regurgitation is 
known .as the water-hammer or Corrigan pulse. It makes 
itself known by an apparent fulness, which, however, soon 
passes, and it recedes from the finger, hence it is also known 
as the receding pulse. The pulse of mitral stenosis is a small, 
irregular, rapid pulse. The dicrotic pulse conveys to the 
finger a double beat. 

Diagnosticate diabetes mellitus. 

The diagnosis of diabetes mellitus consists in the continuous 
presence of glucose in the urine. The amount of urine passed 
by the patient may be from 3 to 5 quarts in the 24 hours ; its 
specific gravity is high, 1030 or over. The color is usually 
straw-colored, and the urine is clear. The patient has great 
thirst, large appetite, 'as a rule loses weight, and an ether ial 
odor may often be detected in the breath; there is pruritus, 
especially of the genitals, and boils and carbuncles are apt to 
form. 

Differentiate gastric cancer from gastric ulcer. 

Gastric cancer occurs after the age of 40, most frequently 
in the male sex; gastric ulcer is a disease most frequently 
occurring in young females in whom chlorosis is often present. 
Gastric cancer is characterized by loss of weight, marked 
cachexia, and often by the presence of a tumor in the region 
of the pylorus. There is pain which, as a rule, is dull in 'char- 
acter and not particularly aggravated by food. Vomiting 
occurs after a longer period, 24 hours or more, of food which 
is but partially digested. The Oppler-Boas bacillus may be 
present in the vomited material, and there may also be tinges 
of blood. In ulcer there is pain and marked tenderness in 
the region of the ensiform cartilage. This pain is greatly 
aggravated by the taking of food ; vomiting occurs soon after 



648 PRACTICE OF MEDICINE. 

a meal ; there is frequently hematemesis. In the examination 
of the gastric contents it will be found that in cancer there is 
an absence of free HC1 and the presence of lactic acid, while 
in ulcer there is an excess of free HC1. 

Differentiate scarlatina, measles and roseola. 

In scarlatina the eruption appears late on the first day or 
early on the second day of the disease, while in measles it 
appears on the fourth day, and in roseola the eruption is the 
first symptom of the disease. The onset in scarlet fever is 
abrupt, with a chill or convulsion, high temperature, rapid 
pulse, 140-160 per minute or more, sore throat, etc. In measles 
the onset is characterized by marked catarrhal symptoms, such 
as sneezing, coughing, lachrymation, etc. ; the temperature 
moderate, there is slight sore throat and mild gastric dis- 
turbance. 

How would you diagnose pneumonia? 

The direct diagnosis of pneumonia depends upon the sudden 
onset with chill, temperature which, as a rule, is high, severe 
pain in the side, cough, at first with scanty expectoration, later 
the expectoration becoming very tenacious and containing 
blood (rusty sputum), and upon the physical signs. These 
consist of the crepitant rale in the first stage, dulness on per- 
cussion in the second stage with bronchial breathing, and the 
occurrence of the crepitus redux in the third stage. 

Differentiate peritonitis and enteritis. 

In peritonitis there are present marked abdominal pain, 
tenderness on pressure, abdominal distension, after which 
effusion is apt to Occur, vomiting, which becomes persistent, 
fever and perhaps 'the occurrence of collapse ; marked consti- 
pation is 'an important symptom. In enteritis there is diar- 
rhoea, there is rarely marked distension, no abdominal rigidity ; 
as a rule, there is the history of some dietary error. 

Differentiate organic and functional heart murmur. 

Organic murmurs may be systolic, presystolic or diastolic in 



PRACTICE OF MEDICINE. 649 

time. There is evidence of cardiac hypertrophy, dilatation, or 
both. The murmur is conducted in certain definite direc- 
tions ( except the presystolic murmur) . A thrill is sometimes 
present. A functional murmur is always systolic in time ; it 
is heard at the base, particularly at the left base (whereas 
the organic murmur is heard at the punctum maximum), it is 
not transmitted, there is no evidence of hypertrophy or dila- 
tation, and it is present in anemic conditions. 

Describe three pathological pulmonary sounds heard on 
auscultation, and give their significance in diagnosis. 

The friction sound which may be heard in inspiration, expi- 
ration or both, which indicates a fibrinous pleurisy. A crep- 
itant rale, which indicates usually fluid in the vesicular struc- 
ture of the lung. Amphoric breathing, showing a cavity. 

Differentiate aortic stenosis and aortic insufficiency. 

In aortic stenosis the murmur is systolic in time, transmitted 
to the arteries of the neck ; a systolic thrill is also often pres^ 
ent, there is some evidence of hypertrophy of the left ventri- 
cle, the pulse is full and, as a rule, not rapid. In aortic 
regurgitation the murmur is diastolic in time, heard at the 
left base, conducted down the sternum. The water-hammer 
or Corrigan pulse is present. There is marked evidence of 
hypertrophy of the left ventricle. Occasionally the "Flint 
murmur" may be heard. 

Differentiate typhoid fever and remittent fever. 

In typhoid fever prodromes are present, such as loss of 
appetite, headache, diarrhea, evening fever, becoming more 
marked each succeeding night. On or about the 7th day the 
characteristic eruption appears, the typical tongue makes its 
appearance, the spleen is enlarged, and the dicrotic pulse is 
found during the second week. The Widal and diazo reac- 
tions are present. Remittent fever may be present in many 
of these cases; there is, however, no Widal or diazo reac- 
tion, no dicrotic pulse, and the presence in the blood of the 
Plasmodium malarias will in all cases lead to a correct diag- 
nosis. 



650 PRACTICE OF MEDICINE. 

Describe four peculiar appearances of the tongue and 
give their significance in diagnosis. 

A flabby, indented, swollen tongue, covered with a yellowish 
fur, shows catarrhal gastritis. This tongue is also seen in 
smokers and drinkers, and occurs often in moderate fevers. 
A tongue which is red at the edges and tips and is coated pos- 
teriorly occurs in enteric fever. The "strawberry" or cat 
tongue, in which the papillae are elevated and a slight grayish 
fur is seen, occurs in scarlet fever. Furrings which are small 
and limited indicate irritation from a rough tooth or inflam- 
mation of a tonsil. 

Differentiate acute rheumatism and periostitis. 

Acute rheumatism is characterized by redness, swelling and 
pain in the joints, by fever of a moderate range, by acid 
sweats and a constant tendency to inflammation of the serous 
membranes of the heart. Periostitis, as a rule, follows an 
injury; the pain is more localized and does not refer to the 
joints ; there are no acid sweats, and pus formation may occur, 
which is exceedingly rare in acute rheumatism. 

Differentiate neuritis from myalgia. 

In neuritis the pain is, as a rule, along the nerve trunks; 
trophic changes may occur. In myalgia padn is over the mus- 
cles; there is no constitutional disturbance; fever is entirely 
absent; pressure upon the affected area in myalgia gives re- 
lief ; in neuralgia the pain is aggravated by pressure. 

Describe the symptoms of yellow fever. 

For convenience of description the disease is divided into 
three stages: The stage of onset, which generally lasts three 
days ; the period of calm, which lasts from 12 to 24 hours ; and 
the period of collapse, the duration of which is indefinite. In 
the first stage there is headache, pain in the bones, nausea and 
vomiting, moderate fever, the pulse may be 80 to 100 in a min- 
ute, 'and becomes progressively slower as the disease advances, 
the urine is albuminous ; there may be even in this stage slight 
jaundice. These symptoms disappear more or less abruptly 



PRACTICE OF MEDICINE. 651 

and give place to the stage of calm, in which all the previous 
symptoms disappear; and recovery from this stage may be 
uninterrupted. If this favorable event should not occur, the 
third stage is ushered in, with the appearance of marked jaun- 
dice, from which the disease receives its name. There may be 
hemorrhage from any of the internal organs, most frequently, 
however, from the stomach, the characteristic black vomit. 
The symptoms of the first stage are added to this. 

Give the diagnosis of gastric ulcer. 

The disease is most frequent in young anemic females. 
There is pain and tenderness on pressure in the region of the 
ensiform cartilage; there is hematemesis and obstinate con- 
stipation. Examination of the gastric contents shows an 
excess of HC1. 

Give the symptoms resulting from paralysis of the 
phrenic nerve. 

This is a paralysis of the diaphragm, if the condition is bi- 
lateral; no movement is noted on the abdomen and epigas- 
trium; the hypochondrium is drawn in; marked dyspnea 
occurs upon the slightest exertion. There may be enlarge- 
ment of the chest. 

What is the significance of the patellar reflex as a sign 
of disease? 

Absence of the knee-jerk is caused by a lesion affecting any 
region of the reflex arc ; it is, therefore, lost in disease affect- 
ing either motor or sensory fibers or both, as in neuritis, in 
disease of the posterior roots or columns, as in Friedreich's 
ataxia. It may be absent in apoplexy, epilepsy, injury to the 
cord and in meningitis; it is sometimes absent in diabetes, 
diphtheria and chorea. It is exaggerated in hemiplegia fol- 
lowing apoplexy, in the cerebral palsies of children, in general 
paralysis of the insane, also in hysteria, neurasthenia and 
strychnine poisoning. 

Differentiate epilepsy from hysteria. 

Epilepsy is often preceded by an aura, followed by complete 



652 PRACTICE OF MEDICINE. 

loss of consciousness. These are at first tonic, followed by 
clonic, convulsions ; during the attack the pupils are dilated ; 
the patients often bite their tongue. In hysteria there is never 
complete loss of consciousness; there is no regularity with 
regard to the 'convulsion ; it is most common in females be- 
tween the ages of 15 and 25 ; the pupils are irregular, hystero- 
genic zones are present, the patient never falls so that she 
may be injured. 

Differentiate neuritis and rheumatism. 

In neuritis the pain is commonly along the nerve trunks; 
trophic changes occur ; there may be foot-drop or wrist-drop ; 
fever is slight. In rheumatism there is redness, swelling and 
pain in the joints, acid sweats, frequent implication of the 
membranes of the heart, marked deposits of urates in the 
urine. 

Differentiate acute phthisis and capillary bronchitis. 

There is a form of acute pulmonary phthisis which is known 
as the broncho-pneumonic form, which can with the greatest 
difficulty only be differentiated from so-called capillary bron- 
chitis. The main points of difference would consist in the 
progressive emaciation, a family history of tuberculosis, the 
finding of tubercle bacilli in the sputum, and the appearance 
of the physical signs in the lungs. 

What are the clinical manifestations of biliary calculi? 

As long as the calculi remain quiescent in the gall-bladder 
no symptoms arise. It is only upon the passage of the gall- 
stones into the duct that the symptoms of hepatic colic arise, 
which consist in great pain in the region of the liver, radiating 
toward the umbilicus and right shoulder-blade, nausea and 
vomiting and, after the passage of stones, jaundice, clay- 
colored stools and the appearance of biliary pigments in the 
urine. 

Differentiate empyema from pulmonary abscess. 

In pulmonary abscess there is a fever of a septic type, the 



PRACTICE OF MEDICINE. 653 

physical signs of a cavity are commonly present, frequently 
expectoration of foul-smelling pus, which under the micro- 
scope shows elastic fibers. In such cases leukocytosis is pres- 
ent. In empyema there are the usual signs of pleural effusion, 
the temperature may range from 102° to 105°, displacement of 
the heart and the adjacent organs is common, local edema 
and redness of the skin are often present. 

Describe the diagnostic characteristics of the eruption 
of typhoid fever, smallpox and chicken=pox. 

The eruption of typhoid fever appears about the seventh 
day, consisting of slightly elevated, rose-colored spots, which 
disappear on pressure and appear again after the pressure is 
removed ; they occur in crops, having a duration of from two 
to three days; they appear commonly on the abdomen, chest, 
between the shoulder-blades, extremely rarely upon the face. 
The eruption of smallpox appears on the third day in the form 
of a macula, passing through the successive stages of vesicle, 
pustule, crust and scar. The pustule is umbilicated and has 
an inflammatory areola; the eruption appears all over the 
body, especially on the exposed parts. The eruption of 
chicken-pox appears on the first day; it appears as a small 
reddish papule, which in a very few hours becomes a vesicle ; 
the vesicle is thin and transparent. 

Differentiate diphtheria from follicular tonsillitis. 

In diphtheria the exudate is found upon all parts of the 
posterior pharynx, uvula and tonsils. Around the exudate 
there is an inflamed areola. The exudate is removed with 
great difficulty, leaving a bleeding surface, the false mem- 
brane rapidly reforming. In follicular tonsillitis the exudate 
is strictly limited to the crypts of the tonsils ; it is wiped away 
with e-ase, without leaving a bleeding surface, and it does not 
reform. The Klebs-Loffler bacillus is found only in the diph- 
theritic exudate. 

Differentiate acute enteritis from acute dysentery. 

In dysentery the important symptoms to be considered are 



654 PRACTICE OF MEDICINE. 

tormina, tenesmus and stools composed of mueus and blood. 
These symptoms in acute enteritis do not occur in anything 
like the severity and constancy that they do in dysentery. 

Differentiate appendicitis from enteric fever. 

As a rule, appendicitis begins abruptly, with marked pain 
in the right iliac fossa over McBurney's point. There is con- 
stipation, tenderness, board-like rigidity, all this occurring, 
as a rule, within a few days. The onset of enteric fever is 
gradual, with prodromes of diarrhea, headache, characteristic 
tongue, appearance of the eruption about the seventh day, 
enlargement of the spleen, dicrotic pulse, Widal reaction. 

Differentiate acute pericarditis from acute endocarditis. 

In pericarditis there is pain in the pericardium. This, as 
a rule, is absent in endocarditis. In pericarditis there is a 
friction sound, which may be either systolic or diastolic, but 
as a rule, is not related to either. In endocarditis there is a 
murmur, which is either systolic, diastolic or presystolic; the 
murmur is transmitted, the friction sound is localized. The 
murmur is heard at the punctum maximum ; the friction sound 
is heard over the body of the heart and is nearer the ear. 

How would you diagnose a case of rickets? 

Sometime between the seventh month and second year of life 
the patient shows irritability, restlessness and some fever 
toward evening, dentition is delayed and gastro-intestinal 
disturbances follow; there is profuse sweating. The shape 
of the head is characteristic ; it is rectangular, the face ap- 
pearing small in proportion to the skull, bone changes are 
noted, and the rachitic rosary appears. 

Differentiate variola and varicella. 

In variola the eruption appears on the third day, preceded 
by marked constitutional symptoms. The eruption goes 
through the successive stages of macule, papule, vesicle, pus- 
tule, which is umbilicated and surrounded by an inflammatory 
areola, crust and scar. The eruption in varicella appears on 



PRACTICE OF MEDICINE. 655 

the first day and is vesicular almost from the beginning. 
There are rarely marked constitutional phenomena, and the 
disease is essentially one of childhood. 

Differentiate apoplexy from uremic coma. 

This is often very difficult; however, the following points 
favor apoplexy: Profound coma, the face may be pale and 
cyanotic or flushed; respiration is stertorous and slow and 
may be of the Cheyne-Stokes type ; hard arteries, with a slow, 
hard, irregular, full pulse; the pupils are dilated or unequal 
and do not react to light ; conjugate deviation of the head may 
be present ; there is evidence of paralysis ; the skin is hot and 
dry; the coma in uremia may be preceded by, or accompanied 
with, convulsions; the face may be pale and edematous; the 
pulse is slow and of high tension, showing either hypertrophy 
of the heart or sclerosis of the vessels ; there may be a urinous 
odor exhaling from the patient; frequently there is edema of 
the feet; albumin and casts are found in the urine; albumi- 
nuric retinitis may be present. 

Differentiate unconsciousness from apoplexy, syncope 
and alcoholic intoxication. 

(Apoplexy see above.) In syncope the face is very pallid, 
the pulse is very weak, and the pupils are markedly dilated. 
In alcoholic coma the unconsciousness is rarely complete. The 
alcoholic odor of the breath is not diagnostic, as apoplexy and 
uremia may occur in persons that have been drinking. The 
pulse is at first rapid and full, later becoming small and fee- 
ble. The pupils are equal and often dilated. The skin is 
cool and moist and the temperature subnormal. 

Differentiate cardiac hypertrophy from cardiac dilata= 
tion. 

In cardiac hypertrophy the apex-beat is displaced down- 
ward and to the left. The first sound of the heart is strong 
and booming. The pulse is slow and strong. In cardiac dila- 
tation the apex-beat is displaced to the right. It is diffused 



656 PRACTICE OF MEDICINE. 

and feeble, the first sound being weak. The pulse is often 
rapid, irregular and weak. 

Differentiate Asiatic cholera from cholera morbus. 

This often presents great difficulties, especially in times of 
an epidemic of cholera; however, the finding of the comma 
bacillus will in all cases clear up the diagnosis. Rice water 
discharges are much more common in true cholera. In cholera 
morbus there is usually the history of an indiscretion in diet. 

Differentiate heat exhaustion from sunstroke. 

In heat exhaustion premonitory symptoms occur, such as 
dizziness, headache, nausea and vomiting. The respirations 
are increased in number, and the pulse is very rapid, 130-140 
per minute. Unconsciousness is not profound. The temper- 
ature may be normal or subnormal, or slight fever may be pres- 
ent. In sunstroke there may or may not be prodromes. The 
temperature is very high, from 106° -115°, or even higher. 
Dyspnea is marked, and the skin of the body is red and some- 
times even livid. The pupils are contracted and the pulse is 
very rapid. There is complete unconsciousness in which con- 
vulsions may occur. Cheyne-Stokes breathing may be present. 

Diagnosticate parenchymatous nephritis. 

The face is pale and edematous. The pulse is full and 
strong, showing some hypertrophy of the heart at first, al- 
though this is not nearly as common as in the interstitial 
variety. The urine is decreased in amount, of high specific 
gravity, high-colored, and contains large amounts of albumin 
and casts. Often there is also edema of the lower extremity. 

Differentiate aortic and mitral valvular diseases. 

In 'aortic disease the murmur is heard with the greatest in- 
tensity at the aortic cartilage (second right costal cartilage) ; 
it is either transmitted to the neck, if it be systolic, or it is 
transmitted down the sternum, if the murmur be diastolic in 
time. In aortic valvular disease there is always hypertrophy 
of the left ventricle. In mitral disease the murmur is heard 



PRACTICE OF MEDICINE. 657 

at the apex. It is transmitted to the axilla and the angle of 
the scapula if the murmur be systolic in time. The presys- 
tolic murmur is not transmitted and is accompanied with a 
presystolic thrill. 

When is perforation in typhoid fever most likely to 
occur? 

Sometime in the course of the third week. 

Describe the essentially different sounds given by the 
thorax on percussion. 

Tympany is elicited over the trachea, resonance over the 
lungs, dulnees over the heart. 

In what cases would the ophthalmoscope aid in diag= 
nosis? 

In disease of the arteries (retinal hemorrhages). In dis- 
ease of the kidney, in disease of the nervous system, syphilis, 
tobacco-poisoning, lead-poisoning, tubercular meningitis, dia- 
betes, etc. 

Differentiate in a general way between cerebrospinal 
fever and tubercular meningitis. 

The onset of tuberculosis is not as sudden as in cerebro- 
spinal meningitis; the pains, hyperesthesia and retraction are 
less, and there are no eruptions. Retraction of the abdomen, 
irregular pulse and Cheyne-Stokes respiration are much more 
frequent. A pre-existing tuberculous lesion may be found, 
and the ophthalmoscope may reveal tubercles in the choroid. 

What does bronchial breathing indicate? 

This is heard normally when listening over the trachea. It 
is encountered over airless spaces in the lung tissue and over 
cavities. 

In what diseases can we employ the microscope to ad= 
vantage as an aid in diagnosis? 

Principally in diseases of the blood and kidney. It is also 
necessary in the examination of all secretions and excretions 
for pathogenic organisms and parasites. 
42 



658 PRACTICE OF MEDICINE. 

Describe the physical signs of simple ascites and those 
of ovarian dropsy. 

In ascites, if the patient be lying upon the back, the center 
of the abdomen is flat (provided the amount of fluid is not 
excessive), the lateral and dependent portions bulge. There 
will be tympany over the region of the umbilicus and flatness 
in the flanks. Fluctuation will be obtained. In dropsy due 
to ovarian disease the accumulation of the fluid is local (in 
the region of the ovary) ; it does not change with the position 
of the patient. If the accumulation be great, the differential 
diagnosis is very difficult ; vaginal examination must be made, 
and sometimes the character of the dropsy can only be deter- 
mined from the fluid withdrawn. 

Differentiate the early eruption of syphilis and measles. 

In syphilis there is the history of the chancre, and quite a 
period (six weeks) before the eruption appears. Coincident 
with the eruption there is inflammation of the throat (mucous 
patches). There is rarely any fever. The eruption is copper- 
colored, and is not particularly prominent on the face. In 
measles there is marked fever from the onset, with severe 
catarrhal symptoms. The eruption does not appear before 
the fourth day, it occurs prominently on the face and rapidly 
spreads all over the body, the catarrhal symptoms continuing. 

What are the methods of physical diagnosis or explora- 
tion? 

Inspection, palpation, mensuration, percussion, auscultation 
and succussion. 

Describe the symptoms of acute inflammatory arti= 
cular rheumatism. 

The disease, as a rule, begins with pain, swelling and red- 
ness of one or more of the large joints. The joints implicated 
are symmetrical. There is, moderate fever, 102°-103°, acid 
sweats and marked urates in the urine. There is a tendency 
to implication of the serous membranes of the heart. 



PRACTICE OF MEDICINE. 659 

Describe the symptoms of a case of apoplexy due to 
cerebral hemorrhage. 

Prodromes may precede the attack, such as nausea, vomit- 
ing, vertigo. As a rule, the attack comes on suddenly, the 
patient becoming comatose., The face is flushed or pale. There 
is stertorous breathing, occasionally of the Cheyne-Stokes 
type. There is conjugate deviation of the head and eyes ; the 
pupils are irregular, and there is evidence of hemiplegia. 

Differentiate acute bronchitis from lobar pneumonia. 

In acute bronchitis there is cough, at first without, later 
with mucopurulent expectoration; subfebrile temperature, 
and slight pain under the sternum. There are no changes 
from the normal on percussion, but upon auscultation there 
are at first dry rales, followed by moist rales. Lobar pneu- 
monia is characterized by sudden onset, with marked chill, high 
temperature, "stitches in the side," cough, a sputum which 
is very tenacious and often rusty; full pulse at first, later 
becoming rapid. The physical signs are quite characteristic. 
There is, in the first stage, the crepitant rale, in the second 
stage dulness on percussion with bronchial breathing and, in 
the last stage, "crepitus redux." 

Differentiate hemoptysis and hematemesis. 

Hemoptysis. Hematemesis. 

Blood is bright red and frothy; often Blood is dark, clotted and often 

coughed up. mixed with food; is vomited. Stools 

may be tarry. 

Alkaline in reaction. Acid in reaction. 

Containing air bubbles. Air bubbles absent. 

Tubercle bacilli may be present in the No tubercle bacilli in the blood, 
blood. 

Differentiate rheumatism from gout. 

Gout occurs suddenly and shows a special preference for 
the smaller joints, especially the great toe. Rheumatism 
comes on more gradually and attacks principally the large 
joints. The appearance of the joint in gout is swollen, glossy, 
tense and bluish. There is less sweating and less fever than 



660 PRACTICE OF MEDICINE. 

in rheumatism; gastric and nervous symptoms are never 
prominent. Implication of the membranes of the heart in 
gout is decidedly less frequent than in rheumatism. 

Differentiate intestinal colic, uterine colic and renal 
colic. 

Intestinal Colic. — Diffuse pain, which may be localized, 
very severe in character ; usually of sudden onset, relieved by 
pressure ; lasting, as a rule, a few hours. A free discharge of 
flatus relieves the attack. 

Uterine Colic. — The pain is in the pelvis, there is some his- 
tory of uterine discharge and disease. 

Renal Colic. — The pain starts from the region of the kidney, 
shooting down the ureter. There is retraction of the testicle ; 
often nausea and sometimes vomiting. 

Give the physical signs of the most usual valvular lesions 
of the heart. 

Mitral insufficiency is the most common valvular lesion of 
the heart. The physical sign is a murmur at the apex, systolic 
in time and transmitted to the left axilla and the angle of the 
scapula. 

Differentiate pleurisy and pneumonia. 

In pleurisy there is a friction sound heard commonly both 
in inspiration and expiration ; fever is slight, there is marked 
pain in breathing. There may be slight cough. In the first 
stage of pneumonia there is a pleurisy, especially when the 
inflammatory exudate reaches the periphery of the lung. 
There is high fever, which is preceded by a marked chill, 
cough, rusty sputum and the physical signs (crepitant rale, 
dulness on percussion, bronchial breathing and crepitus 
redux) . 

What conditions might cause alvine discharges contain= 
ing fat? 

In obstructive jaundice fatty stools are sometimes noted; 
they occur occasionally in overfed infants. Fatty stools are 



PRACTICE OF MEDICINE. 661 

often indicative of disease of the pancreas, such as cancer or 
pancreatic calculi. 

Give the characteristic symptoms of purpura hemor= 
rhagica. 

Hemorrhages from the mucous membranes and extravasa- 
tion in the cutaneous surfaces ; great weakness, anemia due to 
loss of blood. Fever is present, as a rule. 

What conditions increase the amount of uric acid voided 
with the urine? 

Increased by diet (fat and sugar), muscular exercise. In 
the acute fevers (pneumonia and rheumatic fever), in leuke- 
mia and in disease of the spleen generally ; in diabetes and in 
lithemia. It is decreased in amount under strict milk diet, in 
anemia, chronic lead-poisoning and chronic interstitial neph- 
ritis. 

Differentiate thrombosis and embolism. 

Thrombosis. — Prodromes are common, drowsiness and head- 
ache, the onset of the attack is insidious. Hemiplegia gradual 
in onset. Ocular and other nerve palsies. 

Embolism. — Loss of consciousness rapid, hemiplegia and 
disturbances of the pulse and respiration. Embolism is more 
frequent in the left side of the brain, hence valvular disease 
favors embolism. 

What diseases are liable to occur in the right inguinal 
region? 

Appendicitis, floating kidney, disease of the liver and of the 
bladder. 

Distinguish between the terms illusion, delusion and 
hallucination as used in diagnosis. 

An illusion is a wrong conception of an object which really 
exists. A delusion is an absurd and unfounded belief. A 
hallucination is a sense perception without a physical basis. 



662 PRACTICE OF MEDICINE. 

Give the physical and rational signs of pericarditis be= 
fore and after effusion. 

There is slight fever, marked pain in the precordial region, 
dyspnea and irregular, usually quickened, pulse. There is 
pericardial friction on auscultation. When effusion occurs 
the friction disappears ; there is dulness in the precordial area, 
the base of dulness being at the apex of the heart, quite the 
reverse from the usual condition. 

Define vocal fremitus and state its significance in pul= 
monary disease. 

Vocal fremitus means the vibrations of the voice which 
are transmitted to the chest wall. These are conducted from 
the larynx by the trachea and bronchi to the smaller tubes 
within the lungs, and thence through the lung tissue to the 
surface. Vocal fremitus is increased by consolidated lung 
tissue ; it is increased from an empty pulmonary cavity super- 
ficially situated, and is diminished or lost on accumulation of 
fluid in the pleural cavity. 

Differentiate between sunstroke (coup de soleil) and 
apoplexy. 

In sunstroke there is the history of exposure to the sun. 
The temperature is very high, 105° -115° or over, but no evi- 
dence of hemiplegia. In apoplexy there is conjugate devia- 
tion of the head and eyes, hemiplegia, irregular pupils, never 
so high a temperature, and full, bounding pulse. 

What casts are frequently found in albuminous urine 
and what do they denote? 

Hyaline, granular, epithelial and blood casts. Hyaline 
easts probably result from the exudation or secretion of a 
material from the epithelial cells lining the tubules. They 
are sometimes found in healthy individuals. Granular casts 
indicate nephritis. Epithelial casts are always indicative of 
a renal lesion. Blood casts are found in acute parenchyma- 
tous nephritis or in a condition in which the renal tubules 
become filled with red blood corpuscles. 



PRACTICE OF MEDICINE. 663 

Of what import is the spleen in the diagnosis of febrile 
conditions? Give the topography of the spleen. 

As a rule, the spleen is enlarged in all febrile conditions. 
The spleen extends from the ninth rib to the margin of the 
twelfth rib in the midaxillary line of the left side. 

Differentiate the crepitant rales and the subcrepitant 
rales and give the clinical significance of each. 

The crepitant rale is a fine moist rale and is heard only at 
the end of inspiration. It is found in the vesicular structure 
of the lung. The subcrepitant rale is also a fine moist rale, 
somewhat coarser than the crepitant rale, found in the finer 
bronchi and heard both in inspiration and in expiration. 
The crepitant rale is heard in croupous pneumonia, broncho- 
pneumonia, hemorrhage, pulmonary infarcts, edema of the 
lung and sometimes in tuberculosis. The subcrepitant rale 
is heard in congestion and edema of the lungs, in hemorrhage 
or in any condition in which fluid is present in the finer bron- 
chi ; in pulmonary tuberculosis, in the third stage of croupous 
pneumonia and in broncho-pneumonia. 

What are the manifestations of hereditary syphilis? 

The child at birth is very feeble, and the eruption may be 
present ; the child snuffles, the mouth is fissured, and the lips 
are ulcerated. Liver and spleen are enlarged, and bone symp- 
toms are prominent. If the symptoms do not appear at birth, 
they will appear at or about the third month. There is then 
nasal catarrh, with a seropurulent discharge. Necrosis of 
bone is rapid, and the nose undergoes a characteristic de- 
formity. Lesions of the skin also appear. When the teeth 
appear they are notched (Hutchinson's teeth). 

Make a diagnosis of aneurysm of the descending aorta. 

There is marked pain, especially in the back, and a large 
tumor may appear posteriorly in the scapular region. Para- 
plegia may occur from pressure on the cord, dysphagia from 
pressure on the esophagus, and pulmonary symptoms from 



664 PRACTICE OF MEDICINE. 

pressure on the left bronchus. There are, besides, all the 
physical signs of aneurysm in any other locality, such as ex- 
pansible pulsation, tumor, bruit and thrill. 

Make a differential diagnosis of pleuritic and pericardial 
effusion. 

If the pericardial effusion be very great, it may much 
resemble a left-sided pleural effusion. In pericardial effusion, 
however, there is pulmonary resonance at the base, Skodaic 
resonance in the axilla, and the heart is not displaced to the 
right of the sternum. The dyspnea is greater in pericarditis 
with effusion, and the paradoxical pulse may be present. An 
antecedent history of rheumatic fever may help the diagnosis 
and favor pericarditis. 

Describe the treatment of hay fever. 

A change of residence before the annual attack is the only 
prophylaxis ; a correction of the neurotic and gouty tendency 
of the individual should be attempted. A spray to keep the 
nasal passages clean is important. A weak solution of cocaine 
for this purpose is valuable. Suprarenal extract appears to 
give the best results both locally and internally. 

Define epidemic parotitis. What complications may 
arise in the course of this disease? 

There is abrupt development of fever and an enlarged par- 
otid gland on one side. Inflammatory edema of the surround- 
ing tissue is common, the ear may be pushed upward. The 
mouth is displaced and the face disfigured. The fever is 
usually about 102°. In some cases the opposite gland becomes 
affected after a few days. Suppuration does not occur. 
Occasionally other glands, such as the testicles, ovaries and 
mammary glands, are affected. 

Define chlorosis. 

Chlorosis is a form of primary anemia, affecting chiefly 
females at the time of puberty, and characterized by marked 
diminution of the hemoglobin. 



PRACTICE OF MEDICINE. 665 

Give the etiology and describe the symptoms of idio= 
pathic erysipelas. 

It occurs at all seasons of the year and in all climates. It 
is most liable to occur in debilitated and cachectic persons 
and in the course of chronic pulmonary tuberculosis. The 
disease may occur in the puerperal state. The exciting 
cause is the streptococcus erysipelatis of Fehleisen. The dis- 
ease begins with a chill or chilliness, and is followed by the 
development of the eruption. There are gastro-intestinal 
symptoms or fever. The skin becomes irritated, itchy and 
swollen. There is heat, tension and burning in the part. 
The eruption shows decided elevation with a distinct, promi- 
nent margin, it is red or puffy in the center and glossy in 
appearance. Uncomplicated cases last from two to three 
weeks. 

Mention the causes and describe the treatment of pri= 
mary lobar pneumonia. 

The exciting cause is the diplococcus or pneumococcus of 
Frankel. Exposure to cold and wet, alcohol, are said to be 
predisposing causes. The treatment of the disease consists 
in giving the preliminary purge, preferably calomel. Dover's 
powder or a hypodermic injection of morphine to relieve the 
pleural pain, remedies to sustain the heart and respiration, 
such as alcohol and strychnine, are useful. Ammonium car- 
bonate and ammonium chloride are also of value. 

Describe the treatment of hydrothorax. 

Purges, diaphoretics and diuretics are of value. If these 
remedies do not relieve the condition the aspirator must be 
resorted to. 

State your treatment, including diet, of typhoid fever. 

If the patient be seen before the tenth day of the disease, 
a calomel purge should be administered. The systematic cold 
bath of Brand is a favorite method of treatment. Alcohol 
and strychnine are valuable adjuncts to sustain the circula- 
tion. The diet should be absolutely liquid. Water plenti- 



666 PRACTICE OF MEDICINE. 

fully, milk, liquid peptonoids are commonly employed. No 
solid nor semi-solid food should be administered before the 
evening temperature has been normal for at least one week. 

Describe the treatment of diabetes mellitus. 

Diet is most important. No starches or sugars should be 
given. The diet should consist in the fresh green vegetables, 
meat, fish. No alcoholic or malt liquors had better be em- 
ployed. The generally accepted treatment is by some form 
of opium, codeine being most often employed. 

Give the symptoms and treatment of tetanus. 

The prominent symptoms are the occurrence and recurrence, 
at varying intervals, of tonic spasm of greater or lesser inten- 
sity in the voluntary muscles. The spasm is usually first 
noticed in the neck, which is soon followed by spasm of the 
muscles of the jaw, with inability to open the mouth. There 
is pain, which, however, is not severe. Occasionally the body 
arches backward, a condition known as opisthotonos. There 
is usually fever of about 101°, but after prolonged spasm 
hyperpyrexia may occur. The urine is scanty, extremely 
toxic and often contains albumin. Profuse sweating is a 
prominent symptom. The treatment consists in the endeavor 
to administer nutriment, and rectal injections should be re- 
sorted to. Chloral is of value because it produces sleep and 
sometimes relaxes spasm. Antitetanic serum is of value in 
some cases. The wound should be thoroughly cleansed and 
treated antiseptically. 

What is the most common cause of tabes dorsalis? 

Syphilis. 

How should acute coryza be treated? 

Acute coryza should be treated by cleansing the nose with a 
mild antiseptic solution; a weak solution of cocaine is also of 
value. Dover's powder is also recommended internally. 

Describe the treatment of pleurisy with effusion. 

The common measures administered to absorb fluid, such as 



PRACTICE OF MEDICINE. 667 

purges, diaphoretics and diuretics, should be resorted to. If 
these fail the aspirator may be used. 

What is the period of incubation in variola and vaccinia? 

The period of incubation of variola is from ten to thirteen 
days. The period of incubation in vaccinia varies from three 
to seven days, depending upon whether humanized or bovine 
virus is used. 

What are the symptoms of hepatic abscess? In what 
climates is hepatic abscess most likely to occur? 

The symptoms of hepatic abscess are an enlarged and tender 
liver, with jaundice, anemia and wasting. The clinical mani- 
festations vary, and large abscesses may be present without 
marked disturbance. Occasionally fluctuation may be de- 
tected in the liver-. There may be pain of a throbbing char- 
acter. Occasionally all the phenomena of sepsis are present, 
chills, fever and sweating. The disease is most common in 
hot climates. 

How may pleuritis in its early stages be differentiated 
from intercostal neuralgia? 

In pleuritis there is pain, which is especially aggravated by 
breathing. In intercostal neuralgia the pain is over the exit 
of the intercostal nerves. It is increased by pressure. In 
pleuritis the pain is diminished by pressure. The pain is not 
aggravated in intercostal neuralgia by deep breathing. In 
pleurisy there is a friction sound, which does not occur in 
intercostal neuralgia. Frequently intercostal neuralgia is 
accompanied by the development of herpes zoster. 

How many and what are the stages of malarial inter= 
mittent fever? ' 

There are three stages : The stage of chill, the stage of fever, 
and the sweating stage. 

Mention the eruptive fevers. 

Scarlet fever, measles, German or French measles or rubella, 
variola, varicella and erysipelas. 



668 PRACTICE OF MEDICINE. 

Describe the treatment of intermittent fever. 

The treatment of intermittent; fever consists in the admin- 
istration of quinine in sufficient doses to destroy the Plasmo- 
dium of malaria. From 10 to 20 grains a day for an adult is 
sufficient for this purpose. 

Give the etiology and outline the treatment for acute 
gastritis. 

In the majority of instances the condition is due to irritants, 
either thermic or chemical, that come in contact with the 
mucous membrane of the stomach, producing an acute inflam- 
mation. Food either too hot or too cold, spices, drugs and 
poisons may have this influence on the mucous membrane. 
The treatment consists in the administration of a purge, such 
as calomel or castor oil. The diet should be restricted for a 
while. In severe cases it is necessary to produce vomiting. 
Lavage is useful. Drugs are scarcely ever necessary. 

Describe the symptoms and treatment of chronic hydro= 
cephalus in children. 

The symptoms of congenital hydrocephalus are difficulty in 
the movements of the child on account of the weight of the 
head. As a rule there is impairment of intellect. The head 
is often enormous in size. There may be headache and dim- 
ness of vision, and the gait may become irregular. The pulse 
is usually slow. Medical treatment is of no avail in this con- 
dition. Operative methods are advised by some authorities. 

Define rubeola and describe its symptoms. 

Rubeola is an acute, infectious, contagious disease charac- 
terized by marked catarrhal symptoms, especially of the res- 
piratory tract, with a characteristic eruption occurring on the 
fourth day. The disease may begin with a chill, followed by 
fever that may reach 103° F. or higher, with marked catarrhal 
symptoms from the onset. There is injected conjunctiva, 
lachrymation, photophobia, coryza, and some cough. Rales 
are heard in the chest. Koplik's sign may appear about this 
time. On the fourth day the eruption appears, which consists 



PRACTICE OF MEDICINE. 669 

of rose-red or brownish maculo-papular points raised above 
the skin, with intervening healthy skin, often arranged in 
creseentic shape. The eruption remains at its height for about 
four days. The catarrhal symptoms continue. About the 
eighth day of the disease the eruption begins to fade. A fine 
desquamation occurs. In the absence of complications the 
disease lasts about twelve days. 

Describe the symptoms and treatment of gangrene of the 
lung. 

Cough accompanied by expectoration, which is abundant, 
thin and foul-smelling, should call attention to gangrene of 
the lung. Fever is always present. There is often hemop- 
tysis. Microscopically the sputum contains leukocytes, shreds 
of lung tissue, especially elastic fibers, fat crystals and bac- 
teria. Upon percussion over the affected area dulness is pres- 
ent. Upon auscultation, bronchial breathing and, if excava- 
tion occurs, signs of a cavity are present. The treatment is 
supportive. 

Describe the symptoms of tubercular meningitis. 

The course of the disease is usually divided into a pro- 
dromal stage, a period of excitement and a period of paralysis. 
In the prodromal stage the child becomes irritable and rest- 
less, there is anorexia, headache, pain in the limbs, accom- 
panied by nausea and obstinate vomiting. The second 
stage is marked by an aggravation of the symptoms just 
enumerated, with fever. The headache becomes intense, and 
is usually general. The hydrocephalic cry is usually present. 
Obstinate constipation is characteristic. There is a rapid 
pulse, which may be from 120 to 160 per minute ; the abdomen 
is prominent; nervous symptoms are present, most frequently 
delirium. The pupils are contracted, and strabismus may 
occur. There is marked cutaneous hyperesthesia. Convul- 
sive movements are common. This period lasts for a week or 
ten days and is followed by the stage of paralysis. The fever 
becomes higher, often reaching 105° or 106°. Spasmodic 



670 PRACTICE OF MEDICINE. 

contractions, with tremor and twitching of the tendons and 
muscles, with local paralysis occur. The third nerve is most 
frequently involved, causing ptosis. The duration of the dis- 
ease is variable, lasting about three weeks. When the disease 
occurs in adults it may be prolonged to three or four months. 
Leukocytosis is present throughout the course of the disease. 

What should be done for hemoptysis occurring in the 
course of phthisis? 

Absolute quiet is essential ; food and drink should be stopped 
for a while; ice-bags may be applied over the chest; the ad- 
ministration of opium in some form is generally advised. 

Give the symptoms of epidemic influenza. 

The disease occurs suddenly, usually with a chill and marked 
fever, 103° -105°, with catarrhal symptoms, such as sneezing, 
coughing, etc. There is headache, usually frontal or. behind 
the eyes, or at the root of the nose, pain in the limbs and in 
the bones. There is marked prostration, out of proportion to 
all the other phenomena. There is a constant tendency to 
complications resulting from inflammation of the respiratory 
or gastro-intestinal mucous membrane. There may be nau- 
sea and diarrhea. Uncomplicated cases last from a week to 
ten days. 

What is hemoptysis? 

Bleeding from the lungs, 

Give the physical signs of pleuritic effusion. 

On inspection there may be slight bulging. The apex-beat 
of the heart is seen to be displaced. Upon palpation there is 
decreased vocal fremitus. Upon percussion there is flatness 
over the affected area. Upon auscultation the breath-sounds 
are absent, and vocal resonance cannot be obtained over the 
affected area. 

Describe the natural heart sounds. 

Two distinct sounds are encountered: The systolic or first 
sound, and the diastolic or second sound. They are separated 



PRACTICE OF MEDICINE. 671 

from each other by a short pause, a long pause occurring 
between the second and first sound. The first sound is due to 
the contraction of the ventricle, the rush of blood and the 
closure of the auriculo-ventricular valve. It is long, low and 
booming in character. The second sound is due to the closure 
of the semilunar valve, and is short and valvular. The first 
sound is best heard at the apex, the second sound at the base * 
of the heart. 

On what day does the rash usually appear in scarlatina? 

At the end of the first or beginning of the second day. 

What are the symptoms of delirium tremens? 

The prodromes consist of nervousness, restlessness and ano- 
rexia. As a rule there is insomnia. A tremor occurs which 
affects the lips, tongue and limbs. Delirium soon develops, 
which is active and constantly changing. The skin is moist 
and the expression is anxious. The pupils are dilated. The 
temperature is subfebrile, the pulse soft and rapid. The 
tongue is covered with a thick fur, and there is sometimes 
nausea and vomiting. 

What are the clinical features of cerebrospinal fever? 

The onset is sudden, beginning with intense headache, stiff- 
ness in the muscles of the back of the neck, nausea and vomit- 
ing. The attack may begin with a chill. Delirium and stupor 
commonly occur. There is marked alteration of sensation. 
The fever varies from 101°-105° or more. Kernig's sign is 
present. Herpes is very common. Other eruptions also 
occur, such as erythema, urticaria and petechias. Arthritis 
may be present. The urine is scanty and may contain 
albumin. 

Diagnose varioloid. 

The disease begins with a chill, followed by fever of about 
103°. There is Nausea and vomiting, pain in the head and 
back. The eruption occurs earlier than in variola, usually in 
the course of the second day. It is never so copious. The 



672 PRACTICE OF MEDICINE. 

evolution of the pox is arrested in the vesicular stage. There 
is no secondary fever, as there is no pus to absorb. 

Give the symptoms of acute myelitis. 

Paralysis of motion, which comes on rapidly, with complete 
loss of sensation below the site of the lesion, and paralysis of 
the sphincters are the important symptoms. Bed-sores usually 
occur. There is some rise in temperature. Convulsions may 
occur. Reactions of degeneration are not present. The re- 
flexes are exaggerated when the lesion is above the lumbar 
region, and ankle clonus may be elicited. Loss of sensation 
is complete. 

What diseases produce conditions of the skin which are 
of general diagnostic value? 

The eruptive diseases, yellow fever, diseases of the liver, 
purpura, Addison's disease and melanotic cancer. 

What would auscultation and percussion reveal in a case 
of congestion of the lung? 

Auscultation would reveal small moist rales, with broncho- 
vesicular breathing; percussion may reveal impairment of 
resonance. 

What are the physical signs of stenosis of the mitral 
valve? 

A presystolic murmur heard at or near the apex, which is 
not transmitted, a presystolic thrill and a rapid, irregular, 
feeble pulse. 

Describe the features of a case which would lead you to 
diagnose acute appendicitis. 

Marked tenderness and pain in the right iliac fossa, espe- 
cially over McBurney's point; rigidity upon the affected side; 
nausea and vomiting, and marked constipation. 

What does the urine reveal as to color, specific gravity, 
quantity voided, abnormal constituents, etc., in a typical 
case of diabetes mellitus? 

The color is pale yellow with a slight greenish cast ; the spe- 



PRACTICE OF MEDICINE. 673 

cific gravity is high, 1030 or over ; the quantity voided is usu- 
ally large, five quarts or more in twenty-four hours; the 
abnormal 'constituents consist in the presence of glucose; 
occasionally there is also albumin. 

State the sex and period of life to which chlorosis is 
confined. 

It is common in the female sex, rarely occurring in the male. 
It is usually at the age of puberty. 

What are the grades of temperature which come under 
observation in the sick? 

The temperature of collapse is below 96° ; subnormal tem- 
perature is from 96°-97.5° ; normal temperature is 98.6° ; a 
subfebrile temperature is from 99.5° to 101° ; moderate fever 
from 101° to 103°; high fever from 103° to 105°; hyper- 
pyrexia above 105.5°. 

Give the most frequent causes of pericarditis. 

The most frequent causes are rheumatic fever, scarlet fever, 
diphtheria, septicemia and trauma. 

Give the symptoms of an ordinary case of scarlet fever. 

The disease begins suddenly, with chill or a convulsion. 
There is nausea and vomiting, high temperature, rapid pulse 
and marked angina. There is enlargement of the lymphatics 
at the angle of the jaw. At the end of the first or beginning 
of the second day an eruption appears all over the body, which 
has the color of a boiled lobster. The eruption lasts four to 
five days and disappears by desquamation. Postscarlatinal 
nephritis is a frequent complication. 

Describe an attack of acute articular rheumatism. 

The disease begins suddenly, with fever of about 102°-103°. 
There is pain, tenderness, swelling and redness in one or more 
of the large joints. Occasionally prodromes are present. 
There may be a preceding tonsillitis or pharyngitis. The 
involvement of the joints is symmetrical. The pulse is accel- 
erated from 100 to 110 per minute, the urine is high-colored, 
43 



674 PRACTICE OF MEDICINE. 

scanty in amount, specific gravity from 1025 to 1040, contain- 
ing an abundance of phosphates and urates, albumin being 
rarely present. The saliva is strongly acid. Copious acid 
sweats occur. Skin eruptions are common, such as urticaria 
and erythema. 

Give the differential diagnosis between cerebrospinal 
meningitis and typhoid fever. . 

In the first week of the disease the diagnosis is often diffi- 
cult. Later in enteric fever the characteristic eruption ap- 
pears, the spleen enlarges, the pulse becomes dicrotic, the 
nervous symptoms are not prominent until the beginning or 
toward the end of the second week, the headache disappears 
at the end of the first week, the Widal reaction is present. 
In enteric fever the onset is rarely sudden ; there arc marked 
prodromes, such as headache, epistaxis; vomiting is ^very in- 
frequent; the temperature curve in enteric fever is charac- 
teristic, rising step-like in the first week, being subcontinuous 
in the second, remittent in the third and intermittent in the 
fourth week. The onset in cerebrospinal fever is sudden, 
with chill or convulsion ; marked rigidity of the muscles of the 
back of the neck; violent headache and marked vomiting of 
the cerebral type. Herpes is common. The temperature is 
not characteristic, and the nervous symptoms are much more 
prominent than in enteric fever. 

What are the physical signs of pulmonary solidification? 

Upon palpation there is increased vocal fremitus, Upou 
percussion there is dulness, and upon auscultation there is 
bronchial breathing. There may be rales. 

Differentiate catarrhal from croupous pneumonia. 

Catarrhal pneumonia is a disease secondary to bronchitis. 
Croupous pneumonia occurs suddenly, with marked chill, high 
temperature. In croupous pneumonia there is marked pain 
in the side, cough, anxious expression of the face, flush upon 
the cheeks, herpes, rusty sputum, and the disease terminates 
by crisis, usually upon one of the odd days of the disease, 



PRACTICE OF MEDICINE. 675 

fifth, seventh, or ninth day. Broncho-pneumonia occurs most 
coma; only at the extremes of -age. The disease is longer in 
duration, terminating by lysis. Upon physical examination 
in broncho pneumonia there are scattered areas through both 
lungs, over which may be detected subcrepitant rales and 
dulness. Croupous pneumonia is, as a rule, a unilateral dis- 
ease affecting the base of the lung. The crepitant rale, which 
occurs in the first stage, disappears in the second stage and 
reappears in the third stage as crepitus redux, is charac- 
teristic. 

Give the general symptoms of cerebral hemorrhage. 

The onset is sudden, with loss of consciousness, a rapid 
development of hemiplegia, conjugate deviation of the head 
and eyes, usually normal temperature, full, bounding pulse 
and irregular pupils. There may be Cheyne- Stokes respi- 
ration. 

What condition of the blood is generally prominent in 
all forms of rheumatism? 

There is marked anemia, The red bloodcells may be re- 
duced one-half or more in number. The hemoglobin may be 
reduced to fifty per cent., and leukocytosis occurs. 

What adventitious sounds are usually discovered by 
auscultation in catarrhal pneumonia? 

Rales, usually of the subcrepitant variety, large mucus 
rales and broncho -vesicular breathing. 

How are the lymphatic glands involved in scarlatina? 

The lymphatic glands at the angle of the jaw and of the 
neck are usually enlarged, sometimes greatly, so that they 
form what is known as the collar of brawn. 

Give the physical signs of the second stage of acute lobar 
pneumonia. 

There is dulness on percussion, bronchial breathing on aus- 
cultation. 



676 PRACTICE OF MEDICINE. 

Give the topographical outlines of the liver as revealed 
by percussion when the patient is in the recumbent posi= 
tion. 

' Anteriorly liver dulness begins in the mammillary line at 
the sixth rib, in the axillary line at the eighth rib, and in the 
scapular line posteriorly at the tenth rib. It extends from 
all these points to the lowest border of the costal cartilages. 

At what point does auscultation best reveal the sound 
of the mitral valves and of the aortic valves? 

The sound of the mitral valve is best heard at the apex of 
the heart. The sound of the aortic valve is best heard at the 
second right costal cartilage near the sternum. 

Make a diagnosis of locomotor ataxia. 

The disease is commonly divided into three stages : The pre- 
ataxic, the ataxic and the paralytic stage. The pre-ataxic 
stage is characterized by lightning pains, most often in the 
lower extremities, by ocular phenomena, such as the Argyll- 
Robertson pupil, which is a contracted pupil reacting to 
accommodation but not to light, and by the use of the patellar 
tendon-reflex. In the second stage the ataxic gait occurs ; the 
patient cannot stand with his feet in juxtaposition with his 
eyes closed. The symptoms of the pre-ataxic stage continue 
in this stage. The paralytic stage is characterized at first by 
loss of control of the sphincters and by paralysis. 

Give the symptoms of acute spinal meningitis. 

The disease usually begins with chill and a temperature of 
the aseptic type. There is severe pain in the back, increased 
by motion, radiating into the extremities ; rigidity of the mus- 
cles occurs. Hyperesthesia is general. The reflexes are ex- 
aggerated, and ankle clonus is pronounced. There may be 
retention of urine and feces from paralysis of the sphincters. 

What is the period of desquamation in scarlet fever? 

The period of desquamation in scarlet fever usually occurs 
after the appearance of the eruption, or when the eruption 



PRACTICE OF MEDICINE. 677 

has been prominent for about four or five days. It may last 
from several days to several weeks or more. The desquama- 
tion is usually in large scales. 

Define lithemia. 

A condition due to a disturbance of metabolism, character- 
ized by an excess of uric acid in the blood, and clinically by 
various digestive, nervous and circulatory phenomena. 

What are hemic murmurs as applied to the heart, and 
what is their cause? 

It is commonly believed that hemic murmurs are due to an 
alteration in the constituents of the blood, such as occurs in 
chlorosis or in other forms of anemia. These murmurs are 
systolic in time, soft, and heard at the left base of the heart. 

Make a general diagnosis of icterus. 

Jaundice is characterized by a yellowish discoloration of 
the skin and of the conjunctiva. There is itching of the skin, 
slow pulse, the appearance of bile pigment in the urine and 
clay-colored stools. 

Why is dyspnea caused by disorganization of the mitral 
valves? 

This is due largely to the fact that, when rupture of com- 
pensation occurs, the right heart, and hence the pulmonary 
circuit, is interfered with. 

Describe a typical case of laryngismus stridulus. 

The disease comes on abruptly, the child being attacked 
most often at night with shortness of breath, followed by clos- 
ure of the glottis, which may remain closed from several sec- 
onds to twenty or thirty. During this time cyanosis may be 
a prominent feature. This is followed by relaxation of the 
spasm giving rise to high-pitched inspiration. Convulsions 
may occur, and are apt to be very severe. 

Describe a typical case of typhus fever. 

The disease begins suddenly, with marked chill and high 



678 PRACTICE OF MEDICINE. 

temperature. There is nausea, vomiting and epigastric pain. 
The pulse is rapid, hard and not easily compressible. Ver- 
tigo and delirium soon set in. The face is reddened, the pupils 
are contracted and the conjunctiva injected. The tongue is 
coated. The liver and spleen are painful upon palpation 
and are ccmewhat enlarged. Delirium and convulsions are 
common. Constipation is marked throughout the course of 
the disease. On or about the fifth day an eruption occurs, 
which, in its early appearance, closely resembles measles. It 
occurs all over the body except the face. This eruption after- 
ward becomes petechial. Another eruption is chaiacteristic, 
whish consists of marbling or mottling of the skin. On or 
about the fourteenth day of the disease crisis occurs. 

What is the significance of prolonged expiration? 

When inflammatory exudates occur in the bronchial tubes 
the expiratory murmur equals and occasionally is longer than 
the inspiratory nrimur. When this sign is localized to the 
apices it is indicative of incipient tubercular disease. It fur- 
ther occurs in bronchial asthma and in chronic pulmonary 
emphysema. 

What age and sex are most subject to chorea? 

It is a disease of childhood, most common between the fifth 
and fifteenth years ; much more common in the female than in 
the male sex. 

What is understood by an exanthematous fever? 

A fever in which a characteristic eruption occurs. 

What parts of the brain are most liable to hemorrhage? 

The parts supplied by the middle cerebral artery. 

Describe the morbid states associated with asthma. 

They are chronic bronchitis and chronic pulmonary emphy- 
sema. 

What are the general or constitutional symptoms of 
diphtheria? 

The onset of the disease is rapid, the early symptoms being 



PRACTICE OF MEDICINE. 679 

discomfort and weakness, with headache. There is moderate 
fever. Pain on swallowing is often the first symptom. Upon 
examination of the throat the characteristic exudate is seen. 

What are the physical signs of aortic regurgitation? 

Upon inspection the apex of the heart is found displaced 
downward and to the left. The impulse is seen to be forcible, 
indicating great hypertrophy of the left ventricle. Palpation 
confirms this. Upon auscultation a diastolic murmur is noted 
at the second right costal cartilage, transmitted down the 
sternum. The Flint murmur may be present. The pulse is 
characteristic, being known as Corrigan, receding or water- 
hammer pulse. 

On what day does the rash usually appear in measles? 

On the fourth day. 

What is progressive pernicious anemia? 

This is a primary anemia, characterized by a marked de- 
crease in the number of red bloodcells, by fatty degeneration 
of the heart, liver and kidneys, and by a peculiar lemon-yellow 
discoloration of the skin. 

What is Asiatic cholera? 

A specific disease, due to the comma bacillus of Koch, pre- 
vailing endemically in some parts of the world, and occasion- 
ally becoming epidemic, characterized by vomiting, purging, 
muscular cramp and high mortality. 

Enumerate the points of diagnostic value in a case of 
chronic interstitial nephritis. 

Hypertrophy of the heart and arteriosclerosis, albuminuric 
retinitis, headache, the passage of large amounts of urine of 
low specific gravity, 1004 to 1006, traces of albumin and often 
without albumin, and the presence of tube casts. 

Name a medicine which affects the urine as to color and 
odor. 

Turpentine. 



680 PRACTICE OF MEDICINE. 

What cardiac lesions are likely to accompany or to foU 
low acute articular rheumatism? And how may they be 
recognized by the aid of the stethoscope? 

Pericarditis and endocarditis. In endocarditis a murmur 
will be developed ; in pericarditis a friction sound is heard. 

How may rheumatism affect the respiratory organs? 

Pleurisy with or without effusion may occur in the course 
of rheumatic fever. 

What is the usual reaction of the urine in (a) chronic 
cystitis, (b) acute articular rheumatism? 

In chronic cystitis the reaction is usually alkaline ; in acute 
articular rheumatism markedly acid. 

What is the diagnostic significance of dropsy? 

Dropsy is an accumulation of watery fluid in one or more 
of the serous cavities or in the subcutaneous tissues. It is due 
to venous obstruction, to a toxemic condition of the blood, to 
the effects of inflammation upon the neighboring circulation, 
to vasomotor causes relating to disease of the nervous system, 
to lymphatic obstruction, and it occurs in a condition known 
as idiopathic or essential edema. 

Define a puerile murmur and give its causes. 

This form of breathing is normal in infants and children. 
It diminishes in intensity up to the age of twelve years. It 
closely resembles broncho-vesicular breathing. However, the 
ratio between the length of inspiration and expiration is 
always longer. It is occasionally heard in dyspnea, especially 
from disease of the heart. It also occurs in what is known 
as compensatory breathing over one lung when there is disease 
of the opposite lung, or in the portion of one lung when it is 
affected by disease in another part. 

Differentiate between sibilant and sonorous rales. 

Sibilant rales are high-pitched, whistling rales, and occur 
in the smaller bronchial tubes. Sonorous rales are low- 



PRACTICE OF MEDICINE. 681 

pitched, snoring in character, and they occur in the larger 
bronchial tubes. 

Name the leading rational and physical signs of chronic 
bronchitis. 

The important sign of chronic bronchitis is cough, with or 
without expectoration. After chronic bronchitis has existed 
for some time, emphysema frequently occurs, and also bronchi- 
ectasis. The physical signs which belong to chronic bron- 
chitis are, particularly, rales, which are dry rales if there be 
no expectoration, and moist rales if expectoration be profuse. 

Differentiate between pulmonary edema and pneumo= 
nitis. 

Pulmonary edema is usually a secondary disease. There is 
marked dyspnea, urgent and troublesome cough, large num- 
bers of moist rales of all sizes are heard, particularly at the 
base. In pneumonitis there is the onset, with chill, high tem- 
perature, rusty sputum, and the important physical signs, 
which consist in crepitant rales, followed by bronchial breath- 
ing, and the crepitus redux. The termination is by crisis. 

In what conditions does bronchial breathing take the 
place of vesicular breathing? 

Bronchial breathing is encountered over airless spaces in 
the lung tissues and over cavities. Only pulmonary tissues 
containing air have the property of changing into the vesi- 
cular murmur the bronchial sound as it passes through the 
trachea and bronchi. 

What is the character of the fever curve in chronic 
tuberculosis? 

As a rule it is intermittent in character. Occasionally, 
however, the inverse temperature curve is seen. 

What are the physical signs in the first stage of pneu= 
monic fever? 

On inspection there is increased breathing; palpation may 
detect friction fremitus from the associated pleurisy. On 



682 PRACTICE OF MEDICINE. 

percussion there is impairment of resonance, and on auscul- 
tation the crepitant rale is found to be present. 

Relate the history of a case of progressive muscular 
atrophy. 

The early symptoms are pain in the arm and shoulder, with 
numbness and a feeling of exhaustion; next, atrophy is no- 
ticed, as a rule, in one hand. The wasting usually extends 
and the muscles supplied by the ulnar nerve are, as a rule, 
most affected. The motion of the fingers becomes impaired, 
and the wasting gradually passes up from the forearm to the 
arm and shoulder. Both flexors and extensors are affected. 
The other hand usually shows the same process within two to 
ten months. Sometimes the muscles of the shoulder are first 
affected, next the muscles of the back, hip and thigh are in- 
volved. It is rare for the muscles of the legs to be attacked. 
There is paralysis and fibrillary twitching. The reflexes are 
lost early. Reactions of degeneration set in later. One or 
both sides of the face may be affected. The sphincters do 
uot share in this process. 

Describe chronic alcoholism and some of its effects. 

As a rule, the onset is insidious, the symptoms consisting in 
fatigue, unwillingness to work and loss of energy. There is 
malaise, headache, general and mental depression, loss of sleep 
and tremor of the hands, lips and tongue. The tremor at first 
may be controlled. As the condition advances these symptoms 
become more manifest. The skin becomes flabby, the face shows 
venous congestion, and acne may show itself about the nose. 
Symptoms of gastric catarrh are present as a rule. The 
tongue is flabby and furred, and the tremor is marked when 
the tongue is protruded. Leukoplakia may occur, especially 
in males. The breath is fetid, and there is great thirst. 
Often there is disgust for food, especially in the morning, and 
this is aggravated by the early morning nausea and vomiting. 
Insomnia is an early and almost constant symptom, and if the 
patient sleep at all, he is disturbed by bad dreams. Peri- 
pheral neuritis may develop. The will and intellectual facul- 



PRACTICE OF MEDICINE. 683 

ties are greatly impaired, and there is perversion of the moral 
tendencies. The resistance of the body becomes lessened, so 
that drinkers readily succumb to the acute infectious diseases. 

What is the diagnostic significance of Cheyne=Stokes 
respiration? 

This form of respiration is very likely to be observed in 
disease of the brain, from disturbances of the circulation or 
from toxic conditions. 

State where topographically mitral and tricuspid mur= 
murs are most distinctly heard. 

The mitral murmur is heard at or near the apex. The tri- 
cuspid murmur is heard a little to the right of the ensiform 
cartilage. 

Enumerate the diagnostic sounds in a diseased respi= 
ratory apparatus. 

There may be moist or dry rales, crepitant rales, friction 
sounds, bronchial breathing, broncho-vesicular breathing or 
cavernous breathing. 

In what conditions does sub=normal temperature occur? 

This occurs in diabetes, myxedema, chronic cardiac, renal 
and hepatic disease, and in many forms of insanity. It is 
also common in internal malignant growth. It frequently 
occurs after the defervescence in some of the specific fevers. 
It occurs in the stage of collapse in cholera. 

How does paralysis of the third nerve affect the eye? 

There may be ptosis, slight exopthalmus, external stra- 
bismus, diplopia and a dilated pupil which reacts neither to 
accommodation nor to light. 

Give the causes and clinical features of purpura sim= 
plex. 

This condition occurs in many diseases. It is characterized 
by the extravasation of blood into the skin, mucous membranes 
and internal organs, and sometimes by free hemorrhage from 
mucous membranes. The alterations in the composition of 



684 PRACTICE OF MEDICINE. 

the blood in purpura are usually those of symptomatic ane- 
mia from hemorrhage. Purpura simplex is most usually 
met with in children. It is a mild condition, accompanied 
with purpuric spots upon the extremities, and sometimes 
upon the trunk and arms, with impairment of the appetite 
and diarrhea. 

Make a diagnosis of cerebral tumor. 

The characteristic symptoms consist in headache, optic 
atrophy, sensory disturbances, convulsions, vomiting, vertigo 
and bradycardia. The headache is almost constant, and in- 
creases in severity as the disease advances. It may often be 
diffuse, occupying the entire skull. Double optic neuritis is 
very frequent. The temperature is usually normal or sub- 
normal. If, however, the tumor be situated in the pons or 
medulla there may be hyperpyrexia. Occasionally there is 
dyspnea, and also Cheyne-Stokes respiration. Yawning and 
hiccough occur. 

Describe the skin appearances in (a) rubeola, (b) ru= 
bella, (c) scarlatina and (d) varicella. 

(a) In rubeola the eruption appears upon the fourth day. 
It is maculo-papular and coarse. It appears all over the body, 
and is particularly marked upon the face. It is sometimes 
arranged in crescentic form. It disappears by fine desqua- 
mation, (b) In rubella the eruption occurs upon the first day 
irregularly over the face, neck, chest, body and limbs. It is 
a multiform eruption, and may resemble erythema, urticaria, 
and in some cases even measles and scarlet fever. It may be 
confluent or diffuse, and usually lasts from two to four days. 
Desquamation occurs in fine scales, (c) In scarlatina the 
eruption appears at the end of the first day or beginning of 
the second day. It is a bright scarlet eruption, being a true 
inflammation of the skin. It disappears by desquamation, 
which is often in large scales, an entire cast of a hand or foot 
coming away, (d) The eruption in varicella appears upon 
the first day, the exanthem showing itself as small reddish 
points or papules, which in a few hours become vesicles. The 



PRACTICE OF MEDICINE. 685 

eruption is slightly elevated above the skin, rather than hav- 
ing the appearance of being under the skin. The vesicles are 
thin and transparent, and from % to % of an inch in diam- 
eter. The contents are at first clear and transparent. As a 
rule there is no areola. In the course of a few hours the vesi- 
cle becomes milky, and begins to shrivel. The pox may appear 
upon the face, neck, scalp, and some parts of the trunk. 

In what diseases may blood be expectorated? 

As a rule it occurs in chronic pulmonary tuberculosis. It 
sometimes occurs in croupous pneumonia. It may result from 
cancer of the lungs, from abscess of the lung, from bronchi- 
ectasis, ulcerative lesions of the bronchi and frequently in dis- 
ease of the mitral valve. It may occur from aortic aneurysm. 
Malignant disease and parasites of the lung also give rise to 
it. Vicarious hemorrhage (?). It may occur in the hemor- 
rhagic diathesis, in purpura and trauma of the chest wall: 

Give the period of incubation and of eruption of the 
exanthemata. 

The period of incubation in scarlet fever is from four to 
seven days. The eruption occurs at the end of the first or 
beginning of the second day. The period of incubation in 
measles is about ten days. The eruption occurs on the fourth 
day. The period of incubation of rubella is about eighteen 
days. The eruption appears upon the first day. The period 
of incubation in variola is from ten to thirteen days. The 
eruption appears upon the third day. The period of incu- 
bation of varicella is from ten to fifteen days. The eruption 
appears upon the first day. 

Make a differential diagnosis between renal colic and 
hepatic colic. 

The pain in biliary colic radiates over the upper half of the 
abdomen toward the right shoulder. There is tenderness over 
the gall-bladder. The pain in renal colic radiates less over 
the abdomen, but is marked down the ureter to the testicles 
and to the head of the penis, often irritating the rectum. 
There is tenderness over the kidney and in the lumbar region. 



686 PRACTICE OF MEDICINE. 

In biliary colic the vomiting is pronounced and persistent. 
In renal colic vomiting may be present, but is never persistent. 
In biliary colic there are no symptoms relating to the bladder 
or testicle. In renal colic these symptoms are marked. The 
nrine may contain bile in biliary colic. In renal colic the 
urine may contain blood and mucus. Jaundice is present in 
biliary colic, and entirely absent in renal colic. 

Mention and describe, in regard to the feces, abnormal 
conditions that are of diagnostic value. 

Large quantities of mucus may be present in the evacua- 
tions, showing a catarrhal condition of the mucous membrane 
of the intestine. Fat may occur in the stools, and be due to 
disease of the pancreas. Blood occurs from hemorrhage in 
the intestine. Pus may occur from the rupture of an abscess 
situated anywhere in the intestinal tract. Gall-stones and 
enteroliths are also diagnostic. Shreds of tissue and fibrinous 
casts from necrosis occasionally occur. They may be due to 
carcinoma of the bowel. Fibrinous casts occur particularly 
in the course of dysentery. Various forms of animal para- 
sites may also be found in the stools. 

Give the symptomatology of epilepsy. 

As a rule the attack comes on suddenly, the patient falling 
to the ground unconscious. This may or may not be preceded 
by an aura. At first there are tonic spasms, the patient often 
biting his tongue and bloody foam appearing at the mouth. 
This is followed by clonic spasm, and this in turn is succeeded 
by epileptic coma. During the attack the pupils are markedly 
dilated. After the attack the patient usually falls into a 
deep, profound sleep lasting for several hours. 

Make a diagnosis of infantile spinal paralysis. 

The disease begins suddenly, often with convulsions, de- 
lirium and fever. The temperature rises suddenly, usually to 
about 103° F., there is pain in the back and limbs, and some- 
times diarrhea. Paralysis, as a rule, occurs suddenly. The 
paralysis is more extensive early, and the muscles of the par- 
alyzed limb soon undergo atrophy. Reactions of degenera- 



PRACTICE OF MEDICINE. 687 

tion are marked. The legs are most often attacked. Later, 
as a rule, marked improvement takes place. 

How may pleuritic friction sounds be distinguished from 
rales occurring in the bronchial tubes? 

A friction sound is close to the ear ; it is distinctly localized, 
and accompanied by pain on respiration. It may occur in 
inspiration or in expiration or be heard in both. As a rule 
there is no pain with rales ; they are further from the ear and 
are more diffused over the chest. 

What complication should be guarded against in inflam= 
matory conditions of the ear? 

The most important complication relates to an affection of 
the meninges. This is more apt to result from disease of the 
middle ear. 

Define cyanosis and give its causes. 

This is a blue-red condition of the skin, showing itself most 
prominently upon those parts that are normally bright red, 
such as the lips, cheeks, mucous membranes and the finger 
nails. Cyanosis is due to the accumulation of carbonic acid 
in the blood and a deficient amount of oxygen, the blood hav- 
ing a venous or hypervenous character. 

What aids to diagnosis are utilized in the treatment of 
persons affected with stomach lesions? 

Inflation of the stomach may be practiced so as to determine 
the size and position of the stomach. The X-ray may be used. 
A test meal may be given, and the contents of the stomach 
withdrawn after a certain time. The contents are then tested 
for free HC1, pepsin, lactic acid, etc. 

State possible causes of dropsical conditions of the abdo= 
men and lower extremities. 

This is most often due to disease of the heart, kidneys and 
liver. It occasionally occurs from profound anemia, and may 
be due to pressure in the abdomen, as from malignant disease 
or aneurysm. 



688 PRACTICE OF MEDICINE. 

What causes general anemia? Make a diagnosis of 
general anemia. 

By the term anemia is meant a deficiency of the blood, 
either in its bulk or in certain of its constituents. It is usually 
divided into primary and secondary anemia. By the term 
primary — also called essential, idiopathic or cryptogenetic — 
anemia is meant a disturbance of the blood or blood-making 
organs, so that the anemia seems the distinctive feature of the 
disease, while other symptoms appear mainly dependent upon 
this change. Secondary anemia is due to some disease acting 
upon the blood or blood-making organs, the anemia net being 
the prime feature, but a symptomatic manifestation. The 
diagnosis depends upon a change in the blood itself, either in 
a diminution in the hemoglobin or in the number of blood 
corpuscles, or a change in both these constituents. There are 
also constitutional symptoms, such as pallor, shortness of 
breath, especially upon exertion, digestive disturbances and 
nervous symptoms. 

Mention and differentiate the species of tenia. 

In man three species of tapeworm which are fully developed 
commonly occur. The tenia echinococcus occurs only in its 
larval form. The three varieties are tenia solium, tenia 
saginata and the bothriocephalus latus or tenia latus. The 
tenia solium is sometimes called the armed tapeworm, as the 
rostellum is supplied with two rows of hooklets, each row 
containing from twelve to fourteen hooklets. The head is 
quadrilateral, being supplied with four suctorial discs. The 
worm is about four meters long. The segments are from 6-8 
mm. in breadth and from 10-12 mm. in length. In the tenia 
saginata the head is surrounded by four suckers, with a rudi- 
mentary sucker in the middle. The segments measure from 
8-10 mm. in width and are about 18 mm. in length. In the 
tenia lata the worm varies from 5-16 meters in length. The 
head is elongated, and supplied with two grooved suckers, one 
on each side. The breadth (1.8 cm.) of the joints is greater 
than the length. The mature segments show a rosette ar- 
rangement of the uterus which is characteristic. 



INDEX. 



Abdomen, effusion in, 313 

effects of blow, 386 
regions of, 30 
wounds of, 423 
Abortion, 452, 453, 454 

sepsis following, 508 
Abscess, 341, 343 

acute, 328 

differential diagnosis of, 

415 
hepatic, 667 
ischio rectal, 357, 423 
mammary, 492 
pulmonary, 652 
retro-pharyngeal, 646 
vulvovaginal, 379 
Absorption, by blood vessels, 93 
in duodenum, 124 
in stomach, 124 
relative activity of, 
109 
Acacia, 596 
Accommodation, 68 
Acetabulum, description of, 6 
Acetanilid, 549, 560 
Acetone, tests, 299 
Acetous fermentation, 171 
Acid, acetic, 187, 198, 595 
boric, 517 
carbolic, 218, -287, 525, 549, 

603 
carbonic, formula, 240 
citric, 278, 288 
definition of, 180 
essential element of, 179 
gallic, 526, 567 
hydriodic, 289 
hydrobromic, 289 
hydrochloric, 240, 253, 545, 

553 
hydrocyanic, 279, 296, 599 
hydrofluoric, 213 
lactic, 602 
nitric, 165, 240, 596 



Acid, nitric, preparation, 221 
oleic, 569 

oxalic, antidotes for, 228, 296 
salicylic, 524, 559, 583 
sulfuric, 222, 232, 277 
tartaric, 272 
test for, 240 
uric, 216, 234 
Acids, 266 

mineral antidotes, 236 
nitrogen, 254 
organic, 246 
Aconite, 524, 550, 567, 570, 580 
Aconitin, dose of, 547 
Acromegaly, 412 
Adenoma, 341 
Adipose tissue, 305 
Afferent nerve, 101 
Affinity, chemical examples, 178 
Affixes, 164 
Agglutinins, 328 
Air, 320 

changes in by respiration, 81 
elements in four-fifths of, 179 
ground, effect on health, 137 
how differs from nitric oxide, 
182 
stf( 
Albumin, 266 

description of, 179 
urine, tests for, 185 
Albumins, differentiate, 189 
Albuminoids, 192 
Albumose, test, 300 
Alcohol, 200, 230, 238,262 
as a food, 145 
chemical process, 188 
effects of, 134, 531 
how derived, 179 
methylic, 283 
physiological action, 145 
therapy of, 547 
Alcoholic beverages, 215 

intoxication, 394 



44 



(689) 



690 



INDEX. 



Alcoholism, 332, 682 

prescription for, 531 
Aldehydes, 296 
Alimentary canal, 56, 70 
Alkali, 181 

Alkalies, antidotes for, 218 
Alkaloid, 263, 518 
Allantois, 434 

Allotropism, definition of, 198 
Alloy, definition of, 206 
Aloes, source and how eliminated, 

544 
Alum, 544 

composition of, 240 
properties of, 252 
test for, in baking powder, 
290 
Aluminum, 210 

properties of, 185 
Alvine discharges, 660 
Amalgam, definition of, 206 
Amenorrhea, 507 
Amines, 243 
Ammonia, 295, 539 

equation for produc- 
tion of, 182 
gas, 295 

source and use, 281 
uses of , 591 
Ammonium, 274 

bromide, 214 
carbonate, uses of ,543 
chloride, 219 
Amnion, 434 
Amorphous, 181, 257 
Amputations, 344, 362, 409 
Amyl-nitrite, 529 
Amyloid foods, 73 
Analysis, 244 

qualitative, 188 
quantitative, 188 
Anemia, 314. 318, 507, 688 

pernicious, 310, 642, 679 
remedies for, 522 
Anesthesia, compoundsproducing, 
203 
local, 339 
Anesthetics, 173, 537, 573 

contra indications,605 
Aneurysm, 609, 645, 663 

arterio -venous, 412 
pathology of, 325 
sacculated, 380 
Angina pectoris, 617, 629 
Angioleucitis, 315 



Angiomata, 323, 340 

Anhydrid, definition of, 189 

Anhydrous, 288 

Anilin, 296 

Animals, diseases in, 156 

Ankle-joint, internal malleolus, 18 

synovitis in , 342 
Ankylosis, varieties, 356 
Ano-spinal center, in defecation, 

100 
Anodynes, 523 
Antagonist, 541 
Anthelmintics, 565 
Anthrax, 619 
Antidote, 541 
Antimony, 178, 257, 299 
Antipyretics, 568 
Anti pyrin, 554, 581 
Antiseptics, 467, 571, 585 
Antitoxin, 148, 167,576 
Antrum of Highmore, 366 
Aorta, abdominal, 19, 47 
description of, 54 
Aortic insufficiency, 73 

valve, mechanism, 114 
Aphasia. 81,641 
Aphonia, 81 
Apnoea, 122 
Apo morphia, 529, 583 
Aponeurosis, 5 
Apoplexy, 394, 535, 630, 655 

symptoms of, 659, 662 
Apothecaries' weight, 293 
Appendicitis, 22, 640, 654, 672 

McBurney's inci- 
sion, 408 
Appendix vermiformis, 10, 34 
Aqua ammonia, 275 
fortis, 242, 275 
regia, 275 
Arnica, 600 
Arsenic, 172, 299, 580 

in wall paper, 279 

preparations of, 556 

test for in food, 198 

uses of, 534 
Arsenious acid, dose, 580 
Arteries, abdominal aorta, its 

branches, 19, 47 

carrying venous blood, 
100 

degenerative changes in, 
307 

intercostal, 24 

palmar arterial arches, 22 



INDEX. 



691 



Arteries, structure and function, 

93,94 
Artery, axillary branches and re- 
lations, 8 
basilar, 32 
brachial, 23, 402 

ligation of, 1 
coronary, 333 
external carotid, 3 
femoral, 10, 338 
femoral obstruction of, 62, 

63 
internal carotid, divisions 

of, 30 
internal iliac, branches of, 

44 
left common carotid, 33 
ligation of, 344, 376 
lingual, 336 
middle meningeal, 29,320, 

400 
popliteal, branches of, 51 
posterior tibial, 40 
pulmonary, 46 
subclavian, 356 
subclavian, branches of, 

14 
ulnar, 44 
Articulation, temporo-maxillary, 

describe, 54 
Arthritis deformans, 329 
Artisans, 150 
Asafetida, 530 
Ascites, definition of, 325 

physical signs of, 658 
removal of fluid, 397 
Asepsis, definition of, 467 
Asiatic cholera, epidemic of, 129, 

130 
Assimilation, definition of, 99 
Asphyxia, 77 

how causes death, 86 
how produced, 86 
in new-born, 473 
Asthma, 645, 678 

treatment of, 534 
Astigmatism, define, 90 
Astringent, 591 
Atavism, 121 

Atheroma, pathology of, 324 
Atmosphere, 174 

percentage of C0 2 in, 
195 
Atom, 163 
Atomic theory, define, 197 



Atomic weight, 176, 238 

weights, description of 
190 
Atrophy, 306 

causes of, S55 
of liver, 308 

progressive muscular, 
682 
A tropin, 251 

use of, 527 
Atropine combined with mor- 
phine, 544 
dose of, 517 

treatment of poisoning, 
597 
Attraction, 167 
Auditory apparatus, describe, 18 

vertigo, 105 
Aural labyrinth, describe, 51 
Autoinfection, 475 
Autopsy, 230 

Axillary artery, describe, 8 
Axilla, boundaries and contents 

of, 19 
Bacilli, 315 
Bacillus, comma, 317 

tuberculosis, 330 
Back, muscles of, 47 
Bacteria, 308, 315 

in intestines, 109 
in vagina, 475 
Baking powders, 277 
Ballottement, 442 
Balsam of Peru, 519 
Barium, flame test for, 221 
Barley water, 569 
Barometer, 256 
Base, definition of, 187 
Basic radical, definition of, 187 
Bassini's operation, 414 
Bath, cold, dangers of, 137 
Bathing, 139 
Baths, hot, 142 

public, 155 
Battery currents, effect of, on 

nerves, 126 
Beer, 225 

Belladonna. 518, 533, 553, 564, 573 
' alkaloids of, 532 
drugs incompatible 
with, 577 
Benzene, 263 
Benzoin, 595 
Bile, 247 

causes of increased flow, 97 



692 



INDEX. 



Bile, chemical composition of, 185 
-duct, occlusion of, 816 
function of, 116 
reaction of, 276 
salts, 116 
Bilirubin, 300 
Binary compounds, 180, 189 
Bismuth, 254, 294 

preparations of, 557 
salts, 222 

therapy of, 580 
subnitrate, therapeutic 
class of, 532 
Bladder, anatomy of, 38, 64 

arterial supply of, in 

male, 15 
atony of, 361 
blood and nerve supply ,64 
male and female, struct- 
ures, 63 
stone in, 337 
Bleaching, 236 

Bleeding, drugs to arrest, 597 
Blisters, 526 

Blue vitriol, chemical name of, 183 
Blushing, physiology of, 123 
Blood, alkalinity of, how decreased, 
115 
changes in kidneys, 121 

by respiration, 81 
circulation, causes of, 123 
coagulation of, 86 
composition and uses, 92 
conditions retarding coag- 
ulation of, 110 
corpuscles, difference in 

shape, 104 
current, venous, 100 
difference in life and death, 

83 
expectoration of, 685 
extravasated, 314 
heart and lung circulation, 

90 
how cleansed, 88 
in gout, 325 

metallic element in, 177 
movement of in capillaries, 

102 
plasma, 312 
pressure, 111,124, 581 
proportion of in body, 126 
reaction of, 112 
red corpuscles, 65, 98 
renewed after loss, 126 



Blood stains, 76 

stream, comparison of, 90 
test, 299 

vessels, arteries and nerves 
supplying, 52 
functions of, 68 
white corpuscles, 80, 98 
Blow-pipe, 264 

effect on air with flame, 
177 
Body, changes in, following death, 
187 
post mortem of, 316 
protective agencies of, 309 
senile changes in, 329 
temperature, regulation of, 

88 
variations of temperature 
in, 114 
Bone, how nourished, 87 
hyoid, 39 
inflammatory diseases of, 

308, 335 
parietal. 120 
ramus of jaw, 43 
superior maxillary, 39 
Bones, clavical, articulation of, 23 
forming ossa innominata, 

37 
frontal, articulation of, 22 
malar, articulation of, 15 
nasal, 401 

radius, articulation of, 19 
sternum, 38 
Wormian, 42 
Borax, 183, 517, 599 
Boroglycerid, uses of, 214 
Boron, 245 

Brachial artery, ligation of, 1, 402 
Brain, anemia of, 324 

center for articulate speech , 

112 
description of convolu- 
tions, 58 
4th ventricle of, 16 
function of white and gray 

matter, 117 
gray matter of, 116 
hemispheres of, 34 
lobes and fissures of, 11 
membranes of, 12, 76 
motor area, 66, 106 
seat of special senses, 105 
tumor, 359 
ventricles of, 31 



INDEX. 



693 



Brandy, chemically different from 
wine, 178 

Breast, puerperal, diseases of, 512 

Breasts, management of, before 
labor, 449 

Breathing, bronchial, 657, 681 

Brightii morbus, albumin in, 200 

Bromides, 278, 521, 530, 594 

Bromid of ammonium, 214 

Bromine, 174, 179, 197, 218 

Bromism, 545 

Bronchi, respiratory sounds of, 68 

Bronchial tubes, describe, 14 

Bronchitis, 659 

capillary, 652 
chronic, 319, 681 
prescription for, 577 

Broncho-pneumonia, 645 

Bronchorrhea, 586, 643 

Bryonia, 547 

Bubo, treatment of, 384 

Bubonic plague, 157, 312 

Buchu, 553, 554 

Buckthorn, 594 

Buildings, height of, 135 

Bunion, 410 

Bunsen burner, principle of, 179 

Bursae, synovial, 348 

Bursitis, 410 

Burns, 369 

after death, 307 
before death, 307 
classification of, 343 

Butter, 162 

Butyric acid, source of, 291 

Caffein, 536, 570 

Calabar, alkaloids of, 520, 532 

Calcium, 264, 591 

carbonate, formula, 276 
hydrate, graphic forrn- 
* ula, 290 
Calculi, biliary, 224, 618, 628, 652 
urinary, its composition, 
177 
Calculus, vesical, formation of, 

207, 208 
Calomel, compared with podo- 
phyllum, 578 
properties of, 196 
Camphor, 520, 528, 596, 598 
Canal, inguinal, 14, 24 
Candle flame, 273 
Cannabis indica, 532, 558 
Cantharides, tincture, dose, 517 



Cantharis, 555, 583 
Capillary attraction, 243, 286 
Capsicum, ti\, therapy of, 550, 591 
Capsules, suprarenal, describe, 49 
Caput succedaneum, 459 
Carbohydrates, define, 201 

use in body, 99 
Carbolic acid, 242, 287, 603 
Carboligni, 536 
Carbon, 216, 250 

allotropic forms of, 250 
dioxide, 267, 274 
Carbuncle, 341 
Carcinoma, 318, 337 

dissemination of, 341 
histological elements 

of, 321 
pathology of, 322 
Cardamom, uses of, 538 
Caries, dental, 305 
Carron oil, 562 
Cartilage, 73, 80 
Cartilages, arytenoid, 43 
Cascara sagrada, 550, 570 
Castor oil , 595 

Castration, indications for, 349 
Cecum, description of, 30 
Celiohysterectomy, 502 
Cell, according to shape, 103 
giant, 305 
growth, 77 
Cells, how connected, 118 

varieties of, 102 
Cemeteries, 138 
Centigrade, 163 
Cerebellum, its function, 85 
Cerebral hemorrhage, 311 

softening, 304 
Cerebro-spinal fever, 322 
Cerebrum, removal of, 119 
Cerumen, impacted, 385 
Cervical caries, 350 
Cervix uteri, dilatation of, 488 
laceration of, 466 
Cesarean section, 501, 502 
Chancre, 367 
Chancroid, 363, 367 
Charcoal, 593 

Chemical action, 172, 178, 193, 229, 
274, 281 
antidotes, 243 
changes, 197, 222, 265, 

279 
compound, 249 
decomposition, 228 



694 



INDEX. 



Chemical symbol, 239 
Chemistry, 196, 225 
Chest, respiratory action of, 104 
Chicken-pox, eruption of, 653 
Chloral, 212, 535 

hydrate, 223, 248, 565 

poisoning by ,523, 
592 
Chloride of lime, 546 
Chlorides, 278 

Chlorinated lime, how made, 200 
Chlorine, 174, 206 

bleaching process, 236 
element of acid, 178 
occurrence in nature, 1 83 
Chloroform, 212, 230, 246, 268, 564, 
574 
narcosis, 604, 606 
tests for purity, 235 
Chlorosis, 507, 664, 673 
Cholagogue, 529 
Cholera, 129, 153, 612, 679 

Asiatic, epidemic of, 129, 

130 
morbus, 621, 656 
Cholesterin, description of, 102 
Chondrin, where found, 88 
Chorda tympani, 125 
Chorea, 678 
Chromium, 298 
Chyle, 86, 91 
Chyme, 86 
Cicatrices, 307 

Cinchona, derivatives of, 579 
effects of, 523 
tree, 559 
Cinnamon tree, 564 
Circle of Willis, 31 
Circulation, fetal, 470 

of blood, causes, 123 
portal, 108 
renal, 2, 108 
Circumcision, 384 
Cisterns, 150 
Cities, death rate, 156 
Citric acid, 288 
Clavicle, fracture of, 354 
Climate, hot, effects of, 149 
Clubfoot, varieties of, 381 
Coal, 228 

oil, 285 

-tar, products of, 249 
Cocaine, 600 

antagonist of, 526 
effect of, 540 



Codeia compared with morphia, 

583 
Codein, 554 

Coeliac axis, branches of, 51 
Coffee, adulterations of, 133 

use in body, 99 
Coin, 284 
Colchicum plant, 590 

tincture, dose, 517 
uses of, 549 
Cold, how to avoid, 129 
Colic, hepatic, 685 

intestinal, 660 
renal, 660, 686 
uterine, 660 
Colocynth, 602 

extract, dose of, 528 
Collodion, 217 
Collodium, 566 

Collyrium, prescription for, 571 
Color blindness, 76 

sensations of, 107 
Colostomy, 410 
Columnar carnese, 115 
Coma, from injury, 394 
Combustion, 178, 266, 267, 271 
Common carotid artery, ligation 

of, 353 
Complemental air, 82 
Compounds, 226, 287 
Congestion, 408 

active and passive, 
378 
Conium, extract, dose of, 533 

uses of, 530 
Connective tissue, 35, 101 
Consumptives, resorts for. 133 
Convallaria, 536 
Copaiba, 604 
Copper, 227, 598 

preparations of, 521 
sulphate, antidote, 228 
uses of, 528 
Copperas, 551 
Cord, spermatic, 24 
Coronary arteries, 333 
Corpus callosum, 48 

luteum, 75 
Corpuscles, red, 93 

white, 80 
Corrosive sublimate, 196, 521 
Coryza, 666 
Cotton, merits of, 141 
Cough, prescription for, 533, 549, 
589 



INDEX. 



695 



Craniotomy, 501 
Cream of tartar, 253 
Cremation, 141 
Creosote, 577 

source and dose, 584 
therapy of, 554 
with silver nitrate, 552 
Cretinism, 303 
Croup, spasmodic, 615 

treatment of, 599 
Crystalline lens, description of, 12 
Crystallization, 163 
Crystals, source of, 172 
Cubebs, effects and uses, 541 
Cupric nitrate, formula, 276 

sulphate, formula, 278 
Curare, 554 

Cyanogen, description of, 209 
Cyanosis, 687 
Cyst, ovarian, 506, 511 
Cysts, 310 

dermoid, 396 
Cystitis, prescription for, 573 

urine in, 680 
Cystocele, 506 

Death, definition of. 114 

rate, 134 
Decantation, 288 
Decay, 259, 271 
Decomposition, 269, 291 
Degeneration, 306, 319 

amyloid, 309, 327 
calcareous, 308 
colloid, 319 
fibrinous, 322 
mucoid, 319 
renal, 333 
Deglutition, muscles assisting in, 

26 
Delayed union, 364 
Deliquescent, 288 

salt, 238 
Delirium tremens, symptoms of, 

670 
Delusion, 661 

Depressant, vasomotor, 581 
Dermoid cysts, 396 
Destructive distillation, 171, 244 
Dextrin, 255 
Diabetes, 620 

insipidus, 610 
mellitus, 148, 610 

diagnosis, 647 
treatment of, 
666 



Diabetes, mellitus, urine in, 672 
Diabetics, 222 
Diacetic acid, 299 
Dialysis, definition of, 231 
Dialyzer, 231 

Diapedesis, explanation of, 102 
Diaphoresis, 531, 586 
Diaphoretics, 516, 531, 586 
Diaphragm, 11, 98 

in respiration, hic- 
cough, 119 
Diarrhea, prescription for, 573, 590 

treatment of, 592, 630 
Diet, cereal, effects of, 159 
effect of starchy, 111 
for children, 132 
influence of, on nutrition, 

115 
meat, effect of, 77 
Dietary, for aged, 85 
Digestion, gastric, 108, 113 
definition of, 111 
time consumed in, 83 
Digestive fluids, ferments of, 72 

secretions, 66 
Digitalis, 524 

active principles, 575 
habitat and effect of, 556 
infusion, dose, 534 
preparations, 570 
symptoms of poisoning, 
583 
Diphtheria, 147, 160, 317, 613, 653, 
678 
sources of infection. 
127 
Diplococci, 315 
Disease, germ theory of, 152 
sacro-iliac, 352, 377 
Diseases, 314 

caused by water, 160 
endemic, 161 
epidemic, 161 
filth, 158 
germ, 633 
infectious, 162 
of microbic origin, 152 
of school life, 153 
preventable, 156 
prevention of, 153 
pulmonary, causes, 146 
skin lesions of, 672 
Disinfectants, 127, 138 
Disinfection, 195 

by formalin, 129 
Dislocation, 343, 365 



696 



INDEX. 



Dislocation of shoulder-joint, 348 
Dislocations, reduction of, 350 
Distillation, 194. 259 

destructive, 171 
Diuretics, 515, 579 
Drink, precautions observed, 135 

for summer, 135 
Dropsy, 680, 688 

causes of, 313 
ovarian, physical signs of, 
658 
Drugs, increasing peristalsis, 552 

physiological action of, 552 
" Dry earth system," explanation 

of, 131 
Duboisin, 537 
Duct, lachrymal, 357 

pancreatic, obstruction of, 

109 
Stenson's, division of, 121 
thoracic, 24 
Ductless glands, 103 
Ducts, salivary openings of, 36 
Ductus choledochus, 35, 97, 119 
Dura mater, description of, 27 
Dwelling, site for, 157 
Dwellings, dangers of shade, 143 
Dysentery, acute, 653 
Dysphagia, 122,411,609 
Dyspnoea, 122, 677 
Dystocia, 478, 479 

Ear, abscesses of middle, 339 

inflammatorv conditions of, 

687 
suppuration in, 350 
Ecbolics, 516 
Eclampsia, 489, 490 
Ectopic pregnancy, 455, 456 
Eczema, varieties of, 312, 322 
Edema, causes of, 310 

pulmonary, 630, 681 
Efferent nerve, definition of, 101 
Effervescence, definition of, 219 
Efflorescence, definition of, 219 
Effusion, pericardial, 664, 666, 670 
Elaterin, 566 
Elbow, triangle of, 63 

joint, describe, 53 

luxation of, 420 
resection of, 359 
Electric battery, 280 

current, define chemi- 
cally, 190 
light,' 245 



Electricity, 264 

Electrolysis, 288 

Element, diatomic, 294 

monatomic, 294 
negative, definition of, 

184 
positive, definition of, 
184 

Elementary body. 249 

Elements, 226, 227, 229, 243, 274, 
292 
as gases, 241 
as liquids, 241 
division of, 147 
lightest of, 178 
laws governing, 180 
potassium group, 260 
uncombined, 247 

Embolism, 324, 661 

Embryo, 439 

Embryotomy, 501 

Emetics, 555, 574 

Emmenagogues, 533 

Empiric formula, 192 

Empyema, 652 

Emulsion, 263, 556 

Emulsification, 97 

Endemic diseases, 161 

Endocarditis, 610, 631, 633, 654 

Endocardium, 14 

Endometritis, 505 

Endometrium, diseases of, 451 

Endosmosis, 212 

Endothelium, 3 

Energy, muscles source of, 125 

Enteric fever. 654 

Enteritis, 323, 648, 653 

Enzymes, definition of, 204 

Epidemic diseases, 161 

Epidemics, how prevented, 134 

Epiglottis, function of, 117 

Epilepsy, 620.651, 686 

Episiotomy, 465 

Epispadias, 351 

Epistaxis, 391 

Epsom salts, 242 

Epithelia, function of, 78 

Epithelium, varieties of, 52 
ciliated, 85 

Equation, complete, 212 

Equations, 171, 175, 193, 228, 230. 
246, 254, 258, 260, 273 

Ergot, 555, 586 

poisoning by, 520 

Erigerontis oleum, 601 



INDEX. 



697 



Erysipelas, 387, 618, 665 
Erythroxylon, 557 
Escharotics, 572 
Eserin, 564 
Esophagus, 16, 263 

stricture of, 340, 622 
Ether, 230, 232, 291, 606, 607 
chemistry of, 282 
compared with chloroform . 

570 
compound, 186 
how applied, 522 
how obtained, 238 
narcosis, stages, 604 
Ethvl hydrate, 268 

oxid, 262 
Eucalyptus, 585 
Eustachian tube, 11, 75 
Eutocia, 478 
Evaporation, 174 
Exanthemata, 684, 685 
Excavation of streets, 146 
Excipient, 568 
Excretion, definition of, 99 
Excretory glands, 115 
Exhumations, 138 
Exophthalmos, 350 
Expectation of life, 152 
Extracts, 577 

Exudation, diphtheritic, 303 
Eye, 580 

abnormal conditions, 152 
accommodation of, 96 
blood supply of , 31 
ciliary process in, 48 
refracting media of, 112 
tunics of, 40 
Eyeball, description of, 30 

enucleation of, 381, 390 
humors of, 43 
in myopia, 80 
muscles of, 98 
nerves of, 51 

Facial nerve, division of, 355 
function of, 122 
stretching of, 401 

Factories, hygiene of, 156 

Fahrenheit, 163 

Fallopian tubes, 27 

Faradic current, 248 

Fascia, palmar, 59 

Fat, origin of, 67 

Fats, use in body, 99 

Favus, 314 



Feces, 151, 686 

composition of, 118 
Fecundation, 433 
Feeding, artificial, 471, 510 
Fehling's solution, 237 

test, 253 
Female, changes at puberty, 435 
Femoral artery, 10, 339 
Femur, dislocation of head of, 418 
fracture of, 398, 418, 426 
muscles attached, 2 
Fermentation, 204, 220, 268, 271 

acetous, 171 
Ferments, of digestive fluid, 72 
Ferric chlorid, 197 
Ferrous sulphate, 551 
Fetal head, 441 

circulation, 94 
Fetus, death of, 440 

diseases of, 440 

positions of, 448 
Fever, cerebrospinal, 322, 637, 657, 
669, 671 

enteric, 654 

eruptive, 635,667 

exanthematous, 678 

hectic, 314 

inflammatorv, 418 

intermittent, 575, 667, 668, 

remittent, 649 

scarlet, 304, 627, 640 

septic, surgical, 374 

typhoid, 312, 624, 627, 631, 
657, 665, 674 

typhoid, treatment, 639 

typhus, 625, 637, 677 

yellow, 612, 626, 650 
Fibrin, where found, 88 
Fibromata, 306 
Fifth nerve, neuralgia of, 354 
Filtration, 174, 259 
Fire-damp, 220 
Fissure of Sylvius, 45 
Rolando, 45 
Fistula, 349 

in ano, 379 
varieties of, 381 
Fluorin, 174, 213, 298 
Food, carbohydrates, 151 

cooking of, 110 

for child, 151 

for different climates, 137 

for summer, 135 

meat and milk, 119 

precautions in, 135 



698 



INDEX. 



Food, quantity for daily use, 128 

Foods, amyloid, 73 
for aged, 133 
nutritive function, 96 
proteid, 73 
vegetable, 70 

Foot, bones of, 18 

muscle moving it inward, 48 

Foramen ovale, 47 

Forceps, 496, 497, 498, 499, 509 

Forces, changing solid or gas, 277 

Forearm, amputation of, 15 
dislocation of, 368 
flexor muscles of, 5 
fracture of, 409 

Forests, 151 

Formaldehyde, 129 

Formula, empiric, 192 
graphic, 168 
rational, 192 

Formulas, 271 

Fossa, ischio-rectal, 36 

Fossae, nasal, 60 

Fowler's solution, 267 

Fracture, compound, 387 

displacement in, 375 
Potts', 358 
reduction of, 348 
varieties of, 398 
with deformity, 361 

Fractures, 347, 366, 383 

Freezing, 260 

Fruits, in constipation, 148 

Fuel, 161 

Funis, prolapse of, 495 

Furuncle, 341 

G-alactagogue, 588 
Galactorrhea, 492 
Gall-bladder, 6 

stone, impacted, 611 
Galvanic cell, 193 

current, 265 
Gamboge, 603 
Ganglia, of fifth nerve, 14 
Gangrene, 306, 320 
Garbage, 132 
Gas, 176 

coal, treatment of poisoning, 
589 

illuminating, 194, 276 

nitrous oxide, 606 

olefiant, 170 

sewer, prevention of, 133 
Gastralgia, 634 



Gastric cancer, 301 

contents, 300 

digestion. 108 

juice, 76, 92, 112 
Gastritis, 668 
Gastro- duodenitis, 532 
Gastrostomy, 352 
Gelsemium, 527, 593 

poisoning by, 579 
therapy, 594 
Genitalia, female, 379 
Gentian, 592 
Genu valgum, 351 
Germicides, 552 
Gestation, 439 
Giant cell, 305 
Gland, prostate, 23 

thymus, 49 

thyroid, 4, 76 
Glands, 314 

ductless, 103 

excretory, 115 

lachrymal, 50 

lymphatic, 36 

mammary, 39 

meibomian, 2 

of unknown function, 75 

Peyers, 46 

sebaceous, 118 

salivary, 1 

sudoriferous, 118 
Glauber's salt, 247 
Glaucoma, 360 
Gliomata, 350 
Globulins, 189 
Glottis, edema of, 624 
Glucose, 181, 188, 205 
Glucosides, 568 
Glycerin, 186, 264, 600 
Glycogen, how derived, 192 
Goitre, 632 
Gold, symbol of, 178 

official preparations of, 517 
Gonorrhea during pregnancy, 493 
Gossypium, 557 
Gout, 645, 659 

blood in, 325 
pathology of, 324 
treatment of, 615 
Gravitation, 189 
Groin, diseases of, 338 
Guaiac, therapy, 594 
Guaiacum , 565 
Guarana, 551 
Gum arabic, 596 



INDEX. 



699 



Gummata, 308 
Gun cotton, 241 
Gypsum, 242 

Hallucination, 661 
Halogens, 184 
Haloid salt, 272 
Hamamelis, 554 
Hammertoe, 396 
Ham-strings, internal, 24 
Hand, arterial supply, 58 

bones of, 32 
Hair follicle, 42 
Hare-lip, 392 
Haversian system, 52 
Hay fever, treatment of, 664 
Head, muscle moving forward, 48 

bones of. 6 
Health, nuisances dangerous to, 

133 
Hearing, 77, 111 
Heart, 21 

action of, 83, 121 

aortic diseases of, 649 

regurgitation of, 679 

apex beat, 99 

blood supply of, 24 

-beat, 97 

columnse carneae, 115 

dilatation of, 655 

diseases of, 330 

drugs to increase action of, 
539 
retarding action, 559 

exercises affecting it, 104 

fatty degeneration of, 321 

foramen ovale, 47 

hypertrophy of, 320, 655 

left ventricle, 18 

mitral disease of, 672 

murmurs of, 648 

palpitation of, 612 

revolution of, 67 

right ventricle, 3 

sounds, 76, 670, 676 
fetal, 442 

stenosis of valves, 319 

valvular diseases, 656, 660, 
683 

weak, training for, 158 
Heat exhaustion, 656 

how produced in body, 102 
latent, 189 
unconscious by, 154 
Hectic fever, 314 



Hectogram, 167 

Heel, bone forming it, 24 

Hematemesis, 622, 659 

Hematocele, pelvic, 487 

Hematosalpinx. 505 

Hematox3don, 566 

Hematuria, 639 

Hemic murmurs, 677 

Hemoglobin, 122, 247 

Hemophilia, 620 

Hemoptysis, 659, 670 

Hemorrhage, 303, 363, 416 

cerebral, 311, 609, 

675, 678 
drugs to arrest. 597, 

604 
forms of, in obstet- 
rics, 487 
from mucous sur- 
faces, 625 
intestinal, 642 
postpartum, 477 
pulmonary, 625 
secondary, 339 
umbilical, 496 
uterine, 486 

Hemothorax, 638 

Hepatitis, suppurative, 623 

Hernia, abdominal, 340, 399 

congenital inguinal, 422 
femoral. 34, 342 
oblique inguinal, 352, 414 
scrotal, 380 
umbilical, 421 

Herpes progenitalis, 367 
zoster, 632 

Hiccough, treatment of, 539 

High altitudes, 142 

Hip-joint, dislocation, 345, 393 

Hippuric acid, 8S 

Hospitals, 153, 156 

Houses, foundations, 158 
heating of, 150 

Human blood, describe, 84 

Humerus, 2, 4, 11, 378,391 

Humidity, 144 

Hunger, physiology of , 120 

Hydracids, 252 

Hydragogue, 529 

Hydrargyri iodidum rubrum, 558 

Hydrargyrism, 559 

Hydrargyrum, cum creta, 558 

Hydrastis, 180, 561 

Hydrid, 272 

Hydriodic acid, 289 



700 



INDEX. 



Hydrobromic acid, 289 

Hydrocarbon, 248 

Hydrocele, 342 

Hydrocephalus, 493, 619, 668 

Hydrochloric acid, 278, 300 

Hydrocyanic acid, 279, 292 

Hydrogen, 219, 275 

peroxide, 275, 562 
sulfid, 206, 257 
with oxygen, 168 

Hydronephrosis, 643 

Hydrophobia, 373 

Hydrosalpinx, 505 

Hydro thorax, treatment of, 665 

Hydroxid, 287 

Hygiene, 129 

Hygrometer, 256 

Hymen, imperforate, 503 

Hyoscin, 531, 567, 571 

Hyoscvamus, 531, 576 

Hyperemia, 313, 318 

Hypermetropia, 90 

Hypertrophy, 364 

Hypodermic method, precautions 
of, 523 

Hypodermoclysis, 587 

Hypostatic test, 496 

Hypnotics, 570 

Hysterectomy, 476, 501 

Hysteria, 651 



Ice, 135, 152 

artificial, versus natural, 135 

Ichthyol, source and uses, 567 

Icterus, 677 

pathology of, 325 

Iliocecal valve, function of, 117 

Illusion, 661 

Immigrants, 142 

Immunity, 149, 161, 309, 317 

Incompatible, 264 

Incompatibilities, 585, 603 

Incompatibility, 582 

chemical, 525, 533 
therapeutic, 533 

Incubative stages of fevers, 131 

Indican, test, 302 

Indigestion, cause, tea drinking, 
134 
treatment of, 576 

Infant feeding, 137 

Infarct, definition of, 324 

Infection, sources, 349 

Infectious diseases, 162 



Inferior maxillary bone, disloca- 
tion, 348 
fracture of ,389 
Infiltration, 306, 319 

diphtheritic, 303 
Inflammation, 335, 391, 408 
catarrhal , 306 
croupous, 317 
etiology of, 392 
histological changes 

in, 321 
hypostatic, 313 
infective, 304 
of bone, 308 
pelvic, 505 
plastic, 327 
productive, 312, 320 
signs of, 325 
suppurative, 312 
treatment of, 366 
Infammatory conditions, treat- 
ment, 578 
fever, 418 
Influenza, symptoms of, 670 
Inguinal canal, describe, 14 

structures in, 24 
region, diseases of, 661 
Inorganic compounds, 246 

proximate principles, 
124 
Insemination, 432 
Insolation, 618 

Insomnia, prescription for, 529 
Intermittent fever, treatment, 575 
Internal abdominal ring, 45 
Intervertebral substance, 48 
Intestinal obstruction, 337, 427, 

629 
Intestine, large, uses of, 81 

small, glands in, 21 
Intestines, bacteria in, 109 

glands and villi of, 101 
large and small, 94, 95 
vermicular movement 
of, 100 
Intussusception, 342 
Intoxication, 655 
Involution, 469 
Iodids, 278, 287, 557 
Iodin, 174 

antidotes, 223, 531 
test for, 240 
uses of, 527 
Iodism. 560 
Iodoform, 196, 555, 559 



INDEX. 



701 



Ion, 297 

Ionization, 297 

Ipecac, 534, 536, 570 

Iris, action of, 557 

description of, 62 

Iron, 178,217,262,270 

formulas of salts of, 251 
prescription for, 598 

Ischemic paralysis, 307 

Ischio-rectal abscess, 357, 423 

Isomeric, define. 208 

Isomorphous, 187, 188, 257 

Jaborandi, 525, 549 
Jalap, 563 

compared with aloes, 593 
compound powder, 534 
pulvis compositus, 519 
Jaw, ankylosis of. 358 

lower, excision of, 345 
Joint, ankle, 15, 28 

ankylosis of, 372 
elbow, 53, 359 
scapulo-humeral, muscles 

of, 59 
wrist, description of, 26 
Joints, classification of, 7 
shoulder, 7, 378 
tubercular, 316, 326 
Juniper, 597 

Kidney, relations of right, 3 

Kidneys, action of, 68 

action of tr. chloride of 

iron upon, 567 
arteries and veins of, 63 
description of, 27 
impaired function, 91 
location and description 
of, 20 

Knee-joint, 50, 371, 427 

Koumiss, 557 

Kousso, 603 

Labor, 457, 458 

after-pains, 470 
anesthetics in, 466, 467 
antiseptic measures in, 467 
bag of waters during, 461 
care of infant after. 471 

mother after, 469 
causes of delay in, 484 
complicated "by uterine 

fibroid, 511 
conduction of, 472 



Labor, dangers to mother in, 467 
definition of. 456 
delay in second stage, 512 
dilatation of cervix in, 462 
duties of accoucheur dur- 
ing. 468 
examination of woman in, 

465 
injuries during, 508 
ligation of cord, 470 
malposition of fetal head 

in, 479 
mechanism of, 459, 460, 461 
precipitate, 484 
preliminary preparations. 

456 
premature, 452, 455, 470 
premature rupture of 

membrane. 462 
preparation of bed, woman, 

etc., 464 
preparations for, 467 
prolonged, 484 
retention of urine in, 474 
stages of, 462. 463 
uses of ergot in, 468 
vaginal douche in, 468 
Lachrymal duct, stenosis of, 357 
Lactation in primipara. 472 
Lactic acid, source of, 294 
Lactose, chemical differentiation, 

205 
Lactucarium, 519 
Lanolin, 560 

Laryngismus stridulus. 677 
Larynx, anatomy of. 13 
stenosis of, 387 
ventricles of, 63 
Laughing gas, 273 
Law for erection of buildings, 135 

of Gay-Lussac, 284 
Laxative, 593 

| Lead acetate, poisoning from, 192 
poisoning, symptoms, 622 
properties of, 214 
salts, detection of in water, 

203-204 
soluble salt of, 532 
therapy of salts of, 548 
toxicology of. 214 
Leg, amputation of, 345 

muscles forming calf, 4 
of back of, 30 
Lens, crystalline, describe, 12 
Leontiasis ossea, 412 



702 



INDEX. 



Leucin, where found, 88 

Leucocythemia, 82 

Leucomain, 75 

Leukemia, 318, 611, 634 

Life, definition of, 114 

Ligament, Poupart's, describe, 10 
round, 504 

Lignum vitae, 561 

Limonis succus, 565 

Linea alba, 41 

Lingual artery, ligation of, 336 

Linimentum calcis, 562 

Linum, 560 

Lip, epithelioma of, 310 

Lipoma, 323 

Liquid, 176 

specific gravity of, 176 

Liquor ammonii acetatis, 550 
amnii, 434 
calcis, 588 

Liquors, 175 

Litharge, definition of, 214 

Lithemia, 677 

Lithiasis, biliary, 615 

Lithium, 166, 252, 521 

Litholapaxy, 346 

Lithotomy, 346, 427 

Litmus, 211, 227 

Liver, amyloid, 331 

atrophy of, 308, 315 
blood supply of, 22 
cirrhosis of, 317, 322, 616 
function of, 74, 85, 90 
hemorrhage from, 358 
hyperemia of, 328 
ligaments,fissures and lobes, 

35 
nutmeg, 328 
outlines of, 676 

Lobelia, 521 

Locomotor ataxia, 323, 676 

Lotio hydrargyri flava, 547 
nigra, 551 

Lung, congestion of, 672 
gangrene of, 669 
signs of cavity, 638 
solidification of, 674 

Lungs, description of, 27, 50 
impaired function, 91 
respiratory sounds of, 68 

Lunar caustic, 242 

Lupus, 381 

Lymph, best for vaccination, 133 
flow of, how induced, 110 
in vaccination, 133 



Lymph, properties of, 91 

vessels, 327 
Lymphadenitis, 313 
Lymphangitis, 315 
Lymphatic glands, 47, 311, 327 

system, 78 
Lymphatics, how absorb, 93 
Lymphorrhagia, 307, 327 

Magnesia, therapy, 597 
Malarial districts', 161 
Malignant, definition of, 325 
Malleability, definition of, 212 
Malleolus, external, 22 
internal, 18 
Malt, 274 

Maltose, differentiation chemic- 
ally, 205 
Mammary carcinoma, 413 

glands, 39, 371, 447, 449 
description of, 
39 
Man, height and weight of, 138 
Manganese, therapy of, 561 
Manure, 139 

Marble, chemical name of, 183 
Marsh's test, 169 
Mastication, muscles assisting in, 

26 
Mastitis, puerperal, 491 
Materia medica. definition, 537 
Matter, 238, 249, 268, 283 
Measles, 131, 155, 638, 648, 658, 679 
Meat inspection, 144 
Mechanical action, 172 
Meconium, 442 

Median nerve, division of, 369 
Mediastinum, 37, 45 

anterior, 48 
Medicine to promote bone growth, 

601 
Medicines, dose of, 584, 592, 599 

methods of introduc- 
tion, 542 
Medulla oblongata, 49, 118 
M el ano- sarcoma, 317 
Membrana tympani, 372 
Meniere's disease, 105 
Meningitis, 317 

cerebrospinal, 629, 674 
spinal, 676 
tubercular, 657 
Menopause, 507 

Menstruation, 430, 431, 472, 592 
Mentha piperita, 559 



INDEX. 



703 



Mercuric chlorid, 231, 276 

iodid, 289 
Mercurous chlorid, 231, 282, 291 

iodid, 289 
Mercury, 227, 248, 258, 260, 286 
bichloride, 534, 548 
formulas of salts of, 251 
poisoning by, 286 
preparations of, 584 
test for, 168 
therapy of, 584 
Mesentery, description of, 20 
Metabolism, description of, 125 
Metals, 190, 221, 266, 284, 285 

poisonous ones, 207 
Metameric, define, 208 
Metamorphosis, 313, 320 
Methane, formula and properties, 

186 
Metric system, 167, 224, 257 
Metritis, puerperal, 476 
Micrococci, 315 
Microscope, 657 
Micturition, 72 

Middle meningeal artery, 320, 400 
Migraine, 644 
Milium, 384 
Milk, 147, 154, 273, 287 

adulterations of, 140 
constituents of, 222 
diseases communicated 

through, 134 
human, composition of, 107 
remedy arresting secretion 

of, 546 
source of disease, 134 
souring of, 223 
sugar of, 588 
Mineral waters, 164, 210, 239, 278, 

293 
Miscarriage, 452 
Mixture, definition of, 226 
Molecule, 163 
Monad, 209 
Morbus Brightii, 450 
coxae, 372 
coxarius, 352 
Morning sickness, 445 
Morphine, poisoning dose, 535 

tests for, 208 
Mortification, 414 
Mouth, anesthetic for operation, 
341 
hygiene of, 128 
-wash, prescription for, 
571 



Mucous membrane, 104 
Mumps, 632 
Murmur, puerile, 680 
Muscle, action of when stimulated, 
105 
biceps describe, 33 
changes in during con- 
traction, 105 
compressor urethral, 6 
condition of, in tetanus, 

113 
constituents of, 250 
deltoid describe, 32 
flexor profunclis digi- 

torum, 5 
glutens maximus, 29, 48 
internal oblique, 36 
masseter, action of, 48 
rectus abdominis, 37 
sphincter ani, 41 
structure, 95 
trapezius, 7 
tibialis antic us, 42, 48 
Muscles, abdominal, 35 

affections of, 353 
attached to femur, 2 
description of, 4 
forming calf of leg, 4 

quadriceps ex- 
tensor crureus, 
15 
triangle of neck 
anterior, 57 
how divided, 4 
involuntary, function of, 

110 
keeping body erect, 28 
moving humerus, 1 
of orbit, 6 
Muscular contraction, 82, 88, 89 
energy, source of , 125 
fatigue, causes for, 83 
Myalgia, 650 
Mydriatics. 552 
Myelitis, 626, 672 
Myocarditis, 639 
Myoma, definition of, 323 
Myopia, 90, 132 
Myotics, 531 
Myxedema, 644 

Naevus, 360 

Narcotics, 516, 573 

Nasal bones, fracture of, 401 

Nasal fossa, description of, 60 

Nascent state, explain term, 181 



704 



INDEX. 



Necrosis, 428 
Negroes, diseases of, 141 
Nephrectomy, 344 
Nephritis, 656 

acute, 624 

exudative, 643 
in pregnancy, 450 
interstitial, 322, 679 
parenchymatous, 331 
suppurative, 614 
treatment of, 570 
Nephrolithiasis, 621 
Nephrorrhaphy, 344 
Nephrotomy, 344 
Nerve, abducens, function of, 65 
afferent, definition, 101 
cells, 74 

chorda tympani, 125 
efferent, definition, 101 
facial. 53, 122, 355, 401 
fiber, describe, 27 
fibers, 74 
fifth, 99, 354 
fourth cranial, 120 
function of 3rd cranial, 43 
glossopharyngeal, 29 
great sciatic, describe, 8 
median, 23, 369 
nervus opticus, function 

of, 125 
oculomotor, 75 
olfactory, 39 
optic, 6 
pathetic, 120 
phrenic, 44, 651 
pneumogastric, 37, 41, 57, 

107 
radial, 41 , 347 
roots, spinal, 87 
sixth cranial, 3 
spinal accessory, 390 
superior laryngeal, func- 
tion of, 110 
sympathetic, 31, 71 
third cranial, 98 
ulnar, 351 
vasoconstrictor, division 

of, 99 
vasodilator, division of, 99 
Nerves, cranial, name, 11 

ninth pair of cranial, 41 
palm of hand, 62 
pharyngeal plexus, 44 
sclerosis of, 308 
sensory, division of fifth 
pair, 43 



Nerves, spinal, functions of, 113 
third division of fifth, de- 
scribe, 19 
Nervous system, influence on di- 
gestion, 120 
influence on se- 
cretion, 111 
relation to per- 
spiration, 106 
Neoplasms, malignant, 311 
Neuralgia, intercostal, 667 

prescription for, 539 
Neurasthenia, 633 
Neuritis, 650, 652 
Neuroma, definition of, 323 
New-born, food for, 162 
hygiene of, 136 
resuscitation of, 474 
formation, definition of, 326 
Night sweats, treatment of, 526 
Nipple, Paget's disease of, 371 
Nipples, sore, 491 
Nitrates, 247 
Nitre, 242 
Nitric acid, 165, 195, 281, 596 

graphic formula, 290 
oxid, how differs from air, 
182 
Nitrite of amyl, 518 
Nitrites, 247 

Nitrogen, 211, 254, 261,265 
Nitroglycerin, 243, 255, 528, 537 
Nitrous oxide, preparation of, 202 
Non-metals, 190 
Nuisance, 138 

Nuisances, dangerous to health, 133 
Nursing woman, 127 
Nutrition, 115, 124 
Nux vomica, 524, 572 
Obesity, 316 

causes of, 115 
food in, 112, 148 
Occipital bone, articulation of, 18 
Occupations, a menace to health, 

150 
Oil of vitriol, 275 
Ointments, 560, 577, 591 
Oleates, 560 
Olefiant gas, 170 
Oleomargarine, 162 
Oleum gaultheriae, dose of, 518 
morrhuae, 562 
ricini, 588 
theobromae, 515 
tiglii, 521, 541 
Olfactory apparatus, 79 



INDEX. 



705 



Olive oil, 600 

Omentum, great, describe, 9 
Operations, plastic, 387 
Ophthalmia gonorrheal, 324 

neonatorum, 493 
Ophthalmoscope, 657 
Opium, 573, 579, 584 

compared with bella- 
donna, 543 
compared with hyoscine, 

578 
constipating action of, 548 
effect of, on respiration, 

602 
preparations of, 533 
poisoning, 394, 546 
Optic commissure, describe, 8 

nerves, describe, 6 
Orbit, muscles of, 6 
Organic acids, 246 
bodies, 240 
chemistry, description of, 

177 
compounds, 246 
Organs of special sense, 113 
reproductive, 429 
subject to tuberculosis, 
314 
Osmose, 268 
Osmosis, 70 
Ostitis deformans, 412 
Os uteri, rigidity of, 485 
Ovaralgia, 505 

Ovaries, cystic degeneration of, 
506 
location and description 
of, 58 
Ovaritis, 505 
Over-exertion, 142 
-strain, 142 
-training, 142 
Ovulation, 433 
Ovule, 433 
Ovum, 69, 433, 434 
Oxalic acid, 296 
Ox gall, 594 

Oxidation, definition of, 237 
Oxid of carbon, description of, 201 
Oxyacids, 252 

Oxygen, 164, 218, 269, 284, 291 
compounds of, 261 
general description of, 

205 
preparation of , 219, 229 
Ozone, 164, 237 

45 



Ozone, preparation and character- 
istics of, 213 
test, preparation of, 240 

Pain, how produced, 112 
Pallor, physiology of, 123 
Pancreas, 9, 123 

Pancreatic duct, obstruction of, 
109 
juice, reaction of, 112 
Pancreatin, 558 
Papillomata, 320 
Paracentesis thoracis, 340 
Paralysis agitans, 626 
bulbar, 308 
diphtheritic, 626 
infantile spinal, 687 
ischemic, 307 
ocular, 683 
Paraphimosis, 351, 376 
Parasiticide, prescription as a, 550 
Parasiticides, 552 
Paresis, causes of, 325 
Paris green, 237, 242 
Paronychia, 355, 410 
Parotitis, 147,664 
Parturition, premature, 508 
Patella, attachments of, 26 
fractures of, 425 
reflex, 644, 651 
Pelvic floor, 438 
Pelvimitry, 512 
Pelvis, anatomy of, 25 

deformed, 437, 438 
male and female, 435 
obstetric, 436 
Pentad, 209 

element, description of, 
181 
People, old, food for, 133 
Pepo, therapy of, 555 
Pepsin, 239, 558 
Peptones, how produced, 189 
Pericarditis, 630, 637, 654, 662, 673 
Pericardium, describe, 9 
Perineum, how protected in labor, 
465 
laceration of, 466, 509 
male, muscles of, 30 
Periosteum, description of, 41 
Periostitis, 650 

Peristalsis, drugs to promote, 594 
Peritoneum, description of, 49 

relations of, to blad- 
' der, 13 



706 



INDEX. 



Peritonitis, 326, 357, 626, 648 

tubercular, 614 
Pernicious anemia, 310 
Persons catching cold, 129 
Perspiration, uses of, 107 
Pertussis, 147, 615 
Petroleum, preparations, 575 
Peyer's glands, description of, 46 
Pharmacy, 553 
Pharyngeal plexus, 44 
Pharynx, 25, 29 
Phenacetin, 183, 520, 599 
Phenol, 200, 265 
Phimosis, 351, 414 
Phlebitis, 309, 362, 382 

puerperal, 47G 
Phlegmasia alba dolens, 477 
Phosphates, 231, 254 
Phosphorus, 147, 183, 192, 202,242, 
522, 527, 580 
antidotes, 279 
poisoning, 298, 548 
treatment of poison- 
ing, 601 
Photography, 175, 290 
Phthisis, 645, 652 
Physical action, examples of, 193 
change, 196, 265 
diagnosis, 658 
Physician, hygiene of, 128 
Physics, 225 

Physiologic antidotes, 243 
Physiology, human, definition of, 

83 
Physostigma, 527, 597 
Phytolacca, 516 
Pia mater, describe, 32 
Picrotoxin, 584, 587 
Pill, blue, 595 

compound cathartic, 571 
official, 577 
Pilocarpine, 545, 572 

drug antagonistic to, 

518 
drugs incompatible 
with, 577 
Pilocarpus, 534, 564, 596 
Pix liquida, source and dose, 584 
Placenta, 431 

adherent, 473 

dangers of traction on, 

488 
delivery of, 463 
praevia, 487 
retained, 464 



Placenta, separation of, 464 

Plague, 312 

Plaster of Paris, 253 

Plastic operations, 387 

Pleura, description of, 25 

Pleurisy, 621, 660, 667, 687 

Plexus, brachial, 35 
solar, 6 

Plumbi acetatis, 594 

Plumbing, 130 

Pneumogastric nerve, 37, 57, 107 

Pneumonia, catarrhal, 620, 674, 
675 
croupous, 674 
diagnosis, 648 
lobar, 304, 659, 660, 
665, 675 

Pneumonitis, 681 

Podophyllin, therapy, 589 

Poisons, vegetable, 280 

Polymeric, definition of, 208 

Pomegranate, 601 

Pons varolii, parts connected with, 
14 

Popliteal artery, aneurysm of. 346 
space, contents and 
boundaries, 51 

Porosity, 243 

Porro's operation, 502 

Position, 458, 459 

knee-chest, 512 

Potassae liquor, 526 

Potassium, 172, 199, 258, 283, 290 
acetate, dose, 594 
bitartrate, 596 
chlorate, 276, 295, 588, 

600 
cyanide, 241 
group of elements, 179, 

260 
iodide, 165 
nitrate, formula, 219 
permanganate, 286 
salts of, 229, 537, 595 
where found, 180 

Potts' fracture, 358 

Poupart's ligament, description of, 
10 

Powder, Dover's, 544 
Tully's, 544 

Precipitate, definition of, 226 

Precipitation, 259 

Prefixes 206 

Pregnancy, 132, 439, 446, 448, 449 
albuminuria of, 450 



INDEX. 



707 



Pregnancy, diagnosis of, 442, 443, 
444, 511 
diseases during, 452, 

510 
duration of, 445 
effects of, on organ- 
ism, 438 
menstruation during, 

451 
multiple, 494, 511 
painful urination in, 

451 
tubal, 456 
Preparations, official, 538 
Prescription, 536, 561, 572, 576, 

601, 602 
Presentation, breech, 513 
brow, 483 
cephalic, 480 
face, 481, 482, 483 
and breech, 
460, 461 
hand, 484 
head, 460, 461 
impacted breech ,481 
L. O. A., 510 
L.O.P.position,508 
lateral, 483 
leg, 510 

mento-posterior, 482 
occpiito - posterior, 

479 
occiput in hollow of 

sacrum, 480 
pelvic, 480 
R. O. P, 509 
transverse, 483 
Presentations, 448, 449, 458, 459 

vertex, 459 
Privy, 140 

Progressive muscular atrophy, 326 
Prolonged expiration, 678 
Prostatectomy, 421 
Prostatitis, 405 
Proteids, 73, 99, 256 
Protoplasm, 99, 104 
Prunus Yirginiana, 595 
Ptomaines, 146, 166 
Ptosis, 365 
Puerperal mania, 490 
sepsis, 475 
Puerperium, complications of, 472 
definition of, 472 
passing catheter, 470 
sources of infection 
in, 472 



Pulmonary artery, description of, 
46 
diseases, causes of, 146 
sounds, 649 
Pulsatilla, 551 
Pulse, 65, 123, 647 
Pulvis glycyrrhizse compositus, 

525, 568 
Pupil, contraction and dilatation 

of, 118 
Pupils, hours in school, 151 
Purgatives, 575, 593 
Purpura hemorrhagica, 661 

simplex, 683 
Pus cocci, 159 

corpuscles, 323 
formation of, 314 
Pustule, malignant, 386 
Putrefaction, 223, 251, 271, 291 
Pyelitis, treatment of, 625 
Pyemia, 349-352 
Pyuria, 610 

Quadriceps extensor femoris, 375 
Qualitative analysis, 226 
Quarantine, 152 
Quassia, 551 
Quickening, 444 
Quinine, 580, 585 

Kachitis, 622 

Radial nerve, division of, 347 

Eadical, 241, 269 

Rales, 663, 680, 683, 687 

Rational formula, explanation of, 

192 
Rattlesnake bite, 361 
Reaction, alkaline, 249 
chemical, 249 
definition of, 203 
Reagent, chemical, describe, 181 
Rectal feeding, physiology of, 114 
Rectocele, 506 
Rectum, description of, 16, 47 

nerve and blood supply 

of, 26 
stricture of, 344 
Region, left hypochondriac, con- 
tents of, 28 
right hypochondriac, 17 
Reflex action, 65, 87, 95 

deep, integrity of, 91 
superficial, integrity of, 91 
Remedy, cataphoric application 

of, 605 
Remedies, topical, 606 



708 



INDEX. 



Eemittent fever, 649 
Kespiration, 67, 75, 112, 159 

Cheyne-Stokes, 683 
description of, 84 
premature, 495 
quantity of air for, 
139 
Respirations, number per minute, 

117 
Respiratory capacity. 117 

sounds, define, 89 
tract, function of mu- 
cous membrane, 106 
Reserve air, 82 
Residual air, 82 
Resorcin, 566 
Rest cure, 79 
Retina, function of, 104 

rods and cones of, 95-96 
Rheumatic patients, hygiene of, 

128 
Rheumatism, 652, 658, 659, 680 
acute articulf 
articular, 673 
blood in, 675 
cardiac lesions in, 

680 
chronic, 326 
treatment of, 582 
urine in , 680 
Rhubarb, 586 
Rhythm, define, 89 
Ribs, fracture of, 393 
Ricini oleum, 595 
Rickets, 654 
Rigor mortis, 71, 106 
Rochelle salts, chemical name of, 

238 
Roentgen rays, 256 
Roll sulphur, description of, 194, 

195 
Room, temperature for, 132 
Rooms, gases in, 136 
Roseola, 648 
Rotation, 458 

Rotheln, incubation of, 147 
Rubeola, 668 
Rural districts, death rate, 156 

Sabinae oleum, dose, 601 
Saccharin, source and uses of, 588 
Sacro-iliac disease, 352, 377 
Safety lamp, 239 
Saliva, reaction of, 276 
Sal ammoniac, 270 



Salicylic acid, 182 
Salol, 561, 604 
Salpingitis, 504 
Salt, 180, 220, 255 

common, its source, etc., 207 

formula, 240 

neutral, 294 

solution, 348 
Saltpetre, 601 
Salts, Epsom, 587 

Glauber's, 587 

Rochelle, 587 
Santalum album, 566 
Saponification, 97, 282 
Sarcoma. 317, 318 
Sarsaparilla, 596 
Saturation, 276 
Scabies, treatment of, 541 
Scalp wound, 372 
Scammonium, 555 
Scarlatina, 131, 640,648, 671, 673, 
676 
lymphatic glands in, 

675 
rash of, 304 
treatment of, 627 
Scarpa's triangle, boundaries and 

contents. 19 
Scholars, sight of, 130 
School-room, dimensions of, 140 
School-rooms, precautions neces- 
sary, 130, 131 
Sciatica, treatment of, 617 
Sclerosis, multiple, 634 
Scoparius, 567 
Scrotum, diseases of, 337 
Scurvy, 613 

Sebaceous glands, function of, 118 
Secreting surface, epithelial, 92 
Secretion, 99, 117 

Secretions of alimentary canal, 70 
Sedatives, 573, 581 
Seidlitz powder, 239 
Selenium, 298 
Semen, 432 
Seminal fluid, 77 
Senna. 545, 591,600 
Sense of smell, 119 
Septicemia, 352 
Serous membrane, 104 
Serpentaria, 569 
Serum therapy, 574 
Sesqui, meaning of, 180 
Sewage, 159 
Sewer gas, 133, 155 



INDEX. 



709 



Shock, 388, 397 
Shoulder, muscles of, 33 

joint, describe, 7 

dislocations, 348, 
378, 422 
Sialagogue, 528, 588 
Sigmoid flexure, locate, 34 
Silicon, 298 
Silk, merits of, 141 
Silver, 261 

nitrate, 239, 289, 572 
preparations of, 569 
salt of, 248, 563, 590 
symbol of, 178 
tarnished, 217 
test for, 178 
Sinapis, 515 
Sinus, 349 

lateral, describe, 57 
maxillary, describe, 54 
Sinuses, accessory of face, de- 
scribe, 61 
Skeleton, quantity of phosphorus 

in, 225 
Skin, 89, 91, 103 

eruptions, drugs causing, 

531 
hygiene of, 128 
matters excreted by, 103 
minute anatomy of, 56 
tuberculosis of, 321 
Skull, foramina at base of, 17 

fractures of, 371, 375, 377, 

386, 424 
sutures of, 1 
Sleep, 77, 116, 136 

drugs to promote, 578, 605 
Small-pox, 140, 628, 653 
Smell, 119 
Snake bite, 116 
Soap, 263, 297, 599 
Sodium, 227, 264 

chloride, 519 

nitrate, 286 

phosphate, therapy of, 

551 
salicylate, 545 
sulphate, 219,276,519 
Solid, 176 

Solution, definition of, 226 
Donovan's, 528 
Fowler's, 528, 589 
Solutions compared with waters, 

595 
Solvent, 543 



Soot, chemical name of, 255 

Sound conveyed to brain, 103 

Space, popliteal, boundaries and 
contents, 51 

Sparteine, 519 

Spasms, 646 

Special senses, organs of, 113 

Specific gravity, 199, 221, 226, 238 
heat, 272 

Spermatic cord, parts of, 24 

Spermatozoa, 432 

Sphygmograph, description of, 96 

Spigelia, 558 

Spina bifida, 323 

Spinal accessory nerve, resection 
of, 390 
canal, puncture of, 326 
column, 28, 55 
cord, 38, 72, 82, 113 
nerves, 91, 113 

Spirilla, 315 

Spirits, definition, 539 

Spleen, 25, 663 

Sprain, 389 

Sputum, 152, 303 

Stammering, define, 89 

Staph isagria, 539 

Starch, 228, 255 

Sten son's duct, division of, 121 

Sterility, causes of, 452 

Sterilization, 143, 286 

Still-born child, 73, 496 

Stimulant, vasomotor, 581 

Stomach, 122 

cancer of, 364, 632, 647 
corrosion of, 263 
digestion in, 113 
digestion of, 123 
dilatation of, 613 
foreign body in, 405 
lesions of, 687 
pyloric orifice of, 22 
ulcer of, 622, 647, 651 
vermicular movement 
of, 100 

Stomatitis, 644 

Stools, drug affecting color, 604 

Strabismus, operation for, 348 

Stramonium, antidotes, 235 

Stricture, esophageal, 340 

Strontium, flame test for, 221 

Strophanthus compared with digi- 
talis, 542 
tr. dose of, 538 

Strychnia, 272, 531, 578 



710 



INDEX. 



Strychnia, effects of, in cathartics, 

564 
Strychnin, test for, 248 
Strychnine and alcohol compared, 
603 
antidote for, 569 
poisoning dose, 535 
source of , 517 
Subclavian artery, 14, 356 

vein, describe, 5 
Subinvolution, 469 
Sublimation, define an example of, 

194 
Substances fusible by heat, 270 

volatilized by heat, 270 
Sucrose, differentiate chemically, 

205 
Sudoriferous glands, function of 

118 
Sugar, 171, 195, 196, 228 

of milk, 588 
Surf., see also Sulph. 
Sulfate, 260 
Sulfite, 260 

Sulfur, 169, 200, 276, 298,518 
dioxid, 262 
precipitated, 194, 195 
flowers of, 194 
uses of, 218,538 
Sulfuric acid, graphic formula, 290 

antidote for, 204 
Sulfurous acid, 179, 278 
Sulphur ointment, 551, 602 
Sulphuric acid, 277, 279 

manufacture of, 
191 
Sulphuretted hydrogen, 179, 221, 

283 
Sulphonal, 601 
Sunstroke, 618, 656, 662 
Superfetation, 494 
Suppository, prescription for, 571 
Suprarenal capsules, relations, 49 
Surgical fever, 374 
Survivorship, 106 
Sutures, varieties, 361 
Sympathetic nerve, 71 
Symphyseotomy, 500 
Symbiosis, 328 
Symbols, 271 
Syncope, 77, 655 
Synovial bursae, 348 
fluid, 292 
membrane, 104 
Synthesis, 244, 249 



Synthetic operation, 228 
Syphilis, 663 

constitutional, 495 

eruption of, 658 

lesions in, 320 

prescription for, 540 

symptoms of, 366 

treatment of, 578 

Tabes dorsalis, 666 
Talipes calcaneus, 376 

equino-varus, 385, 403, 404 
Tampon, 478 

Tannic acid, drugs incompatible 
with, 576 
source of, 585 
Tannin, 288 
Tape worm , 631 
Tar, uses of, 540 
Taraxacum, 567 

Tartar emetic, 200, 221, 552, 554, 
583 
on teeth. 257 
Tartaric acid, 272, 295 

double salts of, 280 
Tea, 99, 134 
Tear, origin of, 115 
Tears, physiology of, 123 
Teeth, formation of, 53 
growth of, 79 
hygiene of, 128 
permanent and temporary, 

87,88 
replacement of temporary, 

109 
tartar on, 257 

temporary, time of erup- 
tion, 117 
Temperature, drugs for reduction 
of, 578 
grades of, 673 
proper for rooms, 

132 
subnormal, 68 
variations during 
life, 73, 82, 83, 114, 
117 
Temporal bone, mastoid portion 

of, 57 
Tendo Achillis, muscles forming, 

17 
Tendons, compare, 5 
Tenia, 688 
Testes, descent of, 37 

description of, 64 



INDEX. 



711 



Testicle, descent of, 79 
Tetanus 71, 617, 666 
Tetrad, 209 

Therapeutics, definition of, 537 
Thermometer, 211, 216, 256 
Thigh, amputation of, 419 
Thirst, physiology of, 120 
Thorax, 45, 657 
Thrombosis, 319, 362, 661 
Thumb, muscle moving it out- 
ward, 48 
Thymol, source and uses, 540 
Thyroid gland, 4, 76 
Thyroidectomy, 378 
Tic douloureux, 640 
Tidal air, 82 

Tincture and fl. ext., relative 
strength, 592 
definition, 539 
Tinctures, 577 

Tinnitus aurium, causes of, 368 
Tissue, adipose, 305 

connective, function of, 

101 
fibrous, 100, 318 
muscular, describe, 52 
yellow elastic, 100 
Tissues, erectile, their function, 94 
post-mortem changes, 306 
seat of tuberculosis, 311 
separation of, 404 
Tobacco, effects of use of, 132, 154 
Tongue, appearances of, 650 

carcinoma of, 357, 364 
Tonsillitis, 641,653 
Tonsils, description of, 32, 46 
Torticollis, 350 
Towns, death rate, 156 
Toxins for prevention of disease, 

143 
Trachea, describe, 55 

foreign bodies in, 402 
Tracheotomy, 44, 374 
Treatment by cold water, 546 
Trephining, indications for, 375 
Triangle of elbow, structures of, 
63 
Scarpa's, bound, 19 
Trichinosis, 518 
Triple phosphates, 292 
Tubercle, 311, 314, 318 
Tubercula quadrigemina, 2 
Tuberculosis, 145, 161, 681 
Tuberculous joint, 326 
Tubes, Eustachian, describe, 11 



Tumor, benign, 336 

cartilaginous, 335 
cerebral, 684 
definition of, 360 
diagnosis of, 375 
heterologous, 383 
homologous, 383 
malignant, 311, 336, 356 
of brain, 359 
Tumors, classes of, 311 

of fibrous tissue, 318 
Turkish bath, 138 
Turpentine, 277, 543, 597 
Typhoid fever, 160, 312, 624, 631, 
649 
diagnosis, 627 
diet in, 148 
eruption of, 653 
hemorrhage in , 

642 
treatment of, 639 
Tympanum, methods of inflating, 

345 
Tyrotoxicon , 146 

Ulcer, typhoid, 307 

tubercular, 307 
Ulceration, 329, 414 
Ulnar nerves, division of, 351 
Umbilical cord, 434, 435 

souffle, 447 
Urates, 231,270, 272 
Urea, 71 

effect of diet, 277 
how determined, 204 
source of, 252 
Uremia, 394, 534, 623 
Uremic coma, 655 
Ureter, description of, 35 
Ureters, female, course of, 44 
Urethra, female, description of, 17 

male, description of, 46 
Urethritis, gonorrheal, 371 
Uric acid, 177, 241, 292, 661 
Urinalysis, purpose of litmus 

paper, 177 
Urinary calculi, 177,301 
Urination, nervous mechanism, 84 
Urine, 188, 255, 261, 263, 288, 301 
action of drugs on, 679 
albumin, quantitative test, 

233 
ammonia in, 295 
bile in, 233 
blood in, 234 



712 



INDEX. 



Urine, chlorides in, 171 

constituents of, 68, 76, 87, 

107, 166, 198, 272 
drugs to acidify, 599 
examination of. 184, 185, 

186, 216, 224, 227 
in nephritis, 303 
mucin in, 233 
physical properties of, 105 
pigment, 235 
pus in, 403 
quantitative test for sugar, 

234 
retention of, in labor, 474 
test for albumin, 166 

sugar, 253 
tube-casts in, 318, 662 
uric acid in, 241 
Urinometer, 220, 258 
Urticaria, 516 
Uterine bruit, 447 

contractions, stimulation 

of, 458 
hydatids, 435 
inertia, 485 
Uterus, 444 

broad ligaments of, 12 
cancer of, 507 
changes in, during preg- 
nancy, 438 
curettage of, 490 
description of, 431 
dilating of, 504 
displacement of, 451 , 503 
fibroid tumor of, 511 
hour-glass contraction of, 

485 
introduction of hand into, 

499 
inversion of, 488 
irrigation of, 475 
malformations of, 502 
nerves of, 432 
of virgin and of multi- 
para, 42 
regeneration of mem- 
brane, 122 
rupture of, 486 
subinvolution of, 474 
ventrofixation of, 504 
Uva ursae, 533, 562 

Vaccination, views on, 133, 146 
Vaccine virus, 158 
Vaccinia, 667 



Vaccinia, incubation of, 147 
Vagina, describe, 7 
Vaginismus, 503 
Vaginitis, 382 
Valence, 241 
Valerian, 562 
Varicella, 654 

incubation of, 147 
Varicocele, 406 
Variola, 654, 667 

incubation of, 155 
Varioloid, 671 
Varix, 362 
Vascular system, changes in, at 

birth, 47 
Vaseline, source and properties, 

210 
Vein, ascending vena cava, 15 

external jugular, 44 

internal jugular, 26 

subclavian, 5 
Veins, cerebral, 42 

pulmonary, describe, 55 

saphenous, 45 

varicose, 368 
Vena cava, superior, describe, 53 
Venesection, technique of, 568 
Ventilation, 130, 135, 136 
Ventriloquism, 72 
Veratrum viride, 520, 545, 590 
Verdigris, 255 

Vermiform appendix, describe, 10 
Version, 499, 500 
Vertebrae, 6, 22, 28 
Vertigo, cause of, 610 
Vesicants, 590 
Vesiculse seminales, 40 
Vessels, unsanitary condition of, 

148 
Vienna paste, 552 
Vinegar, chemical name of, 255 
Viscera, abdominal, describe, 63 
Vitellus. 434 
Vocal chords, 36, 66 

fremitus, 662 

sounds, how produced, 121 
Voice of male and female, 101 
Volvulus, 340 
Vomiting, 108, 529, 610 
Vulva, 512 
Vulvovaginal abscess, 379 

Wall-paper, 155 

Waste, agents promoting, 553 

Water, 127, 220, 260, 274, 278 



INDEX. 



713 



Water, analysis of, 141, 159, 235, 
249, 266, 297 
boiling, 160 

cause of disease, 144, 160 
characteristics of, 212 
decomposition of, 16.7 
drinking, contamination 

of, 131 
ground, effect on health, 

137 
hard. 143 
hot, 160 

methods of purifying, 131 
mineral, 164 

of crystallization, explana- 
tion of , 181 
rain, 150 
soft. 143 
sources of contamination, 

131 
tepid, 160 

therapy of, 546, 563 
Webbed fingers, 359 
Weights, atomic, description of, 

190 
Wells in streets, 149 
Wet pack, object of use, 129 



I Whiskey, 225 
; Whooping cough, 625, 630 
! Willow, preparations, 575 
Wine. 225 

adulterations of, 157 
chemically different from 
brandy, 178 
Wolffian bodies. 124 
; Wood. 217 
Wool, merits of, 141 
Wound infection, 349 
scalp. 372 
treatment, 336 
Wounds, classification of, 338 
Wrist, amputation at, 413 
■ Wry-neck, operation for, 411 



X-rays, 256 



Yeast. 272 

Yellow fever. 134, 161 
Youth, voice of. 101 
j Young's rule, 584 

; Zinc, 178,185,241,598 
f Zingiber, 553 



s 



J^ ^3. 



t>r9 




